Ferrara Paola Emilia, Codazza Sefora, Coraci Daniele, Malerba Giuseppe, Ferriero Giorgio, Ronconi Gianpaolo
University Polyclinic Foundation Agostino Gemelli IRCCS, Rome, Italy.
High Intensity Neurorehabilitation, University Polyclinic Foundation Agostino Gemelli IRCSS, Rome, Italy.
BMC Musculoskelet Disord. 2021 Nov 29;22(Suppl 2):997. doi: 10.1186/s12891-021-04866-6.
Intra-articular hip injections for osteoarthritis represent a useful instrument to reduce pain and disability in the common clinical practice. Several medications can be injected locally with different level of evidence-based efficacy.
The objective of this systematic review is to investigate the effectiveness of intra-articular injections of different medications or substances for the pain treatment and the management of disability in subjects affected by hip osteoarthritis.
Two reviewers selected independently randomised controlled trials published in the last 10 years, using PubMed and Scopus databases. The risk of bias was evaluated with Cochrane library assessment tool.
12 randomised controlled trials have been selected. We found 8 papers comparing hyaluronic acid with platelet rich plasma, with corticosteroids and with saline solution; 1 paper compares two types of hyaluronic acid with different molecular weights; 3 papers study the effects of corticosteroids alone or compared to ketorolac or saline solution.
The studies reviewed were heterogeneous regarding sample size, level of osteoarthritis, evaluated with Kellegren-Lawrence score, medications used and follow up timings. However, we have observed that intra-articular injections of platelet-rich plasma seem to decrease pain at short term and disability at long term, in patients affected by hip osteoarthritis better than hyaluronic acid. The association of hyaluronic acid and corticosteroids could give better results compared to hyaluronic acid alone, while the use of intra-articular ketorolac and saline solution requires more studies.
髋关节腔内注射治疗骨关节炎是临床常用的减轻疼痛和功能障碍的方法。多种药物可局部注射，其循证疗效水平各异。
本系统评价旨在研究髋关节腔内注射不同药物或物质治疗髋关节骨关节炎患者疼痛及功能障碍的有效性。
两名评价员独立检索过去10年发表在PubMed和Scopus数据库中的随机对照试验。采用Cochrane图书馆评估工具评估偏倚风险。
共纳入12项随机对照试验。我们发现8篇论文比较了透明质酸与富血小板血浆、皮质类固醇和生理盐水；1篇论文比较了两种不同分子量的透明质酸；3篇论文研究了皮质类固醇单独使用或与酮咯酸或生理盐水比较的效果。
纳入研究在样本量、骨关节炎程度（采用Kellegren-Lawrence评分评估）、所用药物及随访时间方面存在异质性。然而，我们观察到，对于髋关节骨关节炎患者，关节腔内注射富血小板血浆在短期内似乎能减轻疼痛，长期来看能改善功能障碍，效果优于透明质酸。透明质酸与皮质类固醇联合使用可能比单独使用透明质酸效果更好，而关节腔内注射酮咯酸和生理盐水的应用则需要更多研究。
