Platelet-Rich Plasma Versus Hyaluronic Acid for Hip Osteoarthritis Yields Similarly Beneficial Short-Term Clinical Outcomes: A Systematic Review and Meta-analysis of Level I and II Randomized Controlled Trials

Published:November 13, 2021DOI:


      To systematically review the literature to compare the efficacy of platelet-rich plasma (PRP) and hyaluronic acid (HA) injections for the treatment of hip osteoarthritis (OA).


      A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials that compared the clinical efficacy of PRP and HA injections for hip OA. The search phrase used was hip, osteoarthritis, platelet-rich plasma, hyaluronic acid, randomized. Patients were assessed based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Visual Analog Scale (VAS) for pain, and the Harris Hip Score (HHS). Subanalyses were performed for any outcome score in which ≥3 studies reported results.


      Six studies (5 level I, 1 level II) met inclusion criteria, including 211 patients undergoing intra-articular injection with PRP (mean age 60.0 years, mean follow-up 12.2 months) and 197 patients with HA (mean age 62.3 years, mean follow-up 11.9 months). No significant differences were found in the weighted improvement of any outcome score (WOMAC, VAS, or HHS) from preinjection to postinjection between groups. When excluding a study with the highest risk of bias to eliminate heterogeneity, pooled subanalysis demonstrated no significant differences in WOMAC subscores between PRP and HA groups. Similarly, in a pooled subanalysis that isolated patients treated with leukocyte-poor PRP, no significant differences in WOMAC subscores were found between PRP and HA groups.


      Patients undergoing treatment for hip OA with either PRP or HA injections can expect to experience similarly beneficial short-term clinical outcomes.

      Level of Evidence

      II, systematic review of level I and II studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Grazio S.
        • Balen D.
        Obesity: Risk factor and predictor of osteoarthritis.
        Lijec Vjesn. 2009; 131: 22-26
        • Lawrence R.C.
        • Felson D.T.
        • Helmick C.G.
        • et al.
        Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II.
        Arthritis Rheum. 2008; 58: 26-35
        • Dallari D.
        • Stagni C.
        • Rani N.
        • et al.
        Ultrasound-guided injection of platelet-rich plasma and hyaluronic acid, separately and in combination, for hip osteoarthritis: A randomized controlled study.
        Am J Sports Med. 2016; 44: 664-671
        • Di Sante L.
        • Villani C.
        • Santilli V.
        • et al.
        Intra-articular hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis.
        Med Ultrason. 2016; 18: 463-468
        • Mauro G.L.
        • Scaturro D.
        • Sanfilippo A.
        • Benedetti M.G.
        Intra-articular hyaluronic acid injections for hip osteoarthritis.
        J Biol Regul Homeost Agents. 2018; 32: 1303-1309
        • Altman R.D.
        • Manjoo A.
        • Fierlinger A.
        • Niazi F.
        • Nicholls M.
        The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: A systematic review.
        BMC Musculoskelet Disord. 2015; 26: 321
        • Bowman S.
        • Awad M.E.
        • Hamrick M.W.
        • Hunter M.
        • Fulzele S.
        Recent advances in hyaluronic acid based therapy for osteoarthritis.
        Clin Transl Med. 2018; 7: 6
        • Chevalier X.
        • Jerosch J.
        • Goupille P.
        • et al.
        Single, intra-articular treatment with 6 ml hylan G-F 20 in patients with symptomatic primary osteoarthritis of the knee: A randomised, multicentre, double-blind, placebo controlled trial.
        Ann Rheum Dis. 2010; 69: 113-119
        • Belk J.W.
        • Kraeutler M.J.
        • Houck D.A.
        • Goodrich J.A.
        • Dragoo J.L.
        • McCarty E.C.
        Platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials.
        Am J Sports Med. 2021; 49: 249-260
        • Bennell K.L.
        • Hunter D.J.
        • Paterson K.L.
        Platelet-rich plasma for the management of hip and knee osteoarthritis.
        Curr Rheumatol Rep. 2017; 19: 24
        • Dai W.L.
        • Zhou A.G.
        • Zhang H.
        • Zhang J.
        Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: A meta-analysis of randomized controlled trials.
        Arthroscopy. 2017; 33: 659-670
        • Filardo G.
        • Kon E.
        • Pereira Ruiz M.T.
        • et al.
        Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 2082-2091
        • Kabiri A.
        • Esfandiari E.
        • Esmaeili A.
        • Hashemibeni B.
        • Pourazar A.
        • Mardani M.
        Platelet-rich plasma application in chondrogenesis.
        Adv Biomed Res. 2014; 3: 138
        • Sundman E.A.
        • Cole B.J.
        • Karas V.
        • et al.
        The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis.
        Am J Sports Med. 2014; 42: 35-41
        • Higgins J.P.
        • Green S.
        Cochrane handbook for systematic reviews of interventions version 5.1.0.
        The Cochrane Collaboration, London2011
        • Bellamy N.
        • Buchanan W.W.
        • Goldsmith C.H.
        • Campbell J.
        • Stitt L.W.
        Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.
        J Rheumatol. 1988; 15: 1833-1840
        • Harris W.H.
        Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end-result study using a new method of result evaluation.
        J Bone Joint Surg Am. 1969; 51: 737-755
        • Doria C.
        • Mosele G.R.
        • Caggiari G.
        • Puddu L.
        • Ciurlia E.
        Treatment of early hip osteoarthritis: ultrasound-guided platelet rich plasma versus hyaluronic acid injections in a randomized clinical trial.
        Joints. 2017; 5: 152-155
        • Kraeutler M.J.
        • Houck D.A.
        • Garabekyan T.
        • Miller S.L.
        • Dragoo J.L.
        • Mei-Dan O.
        Comparing intra-articular injections of leukocyte-poor platelet-rich plasma versus low molecular weight hyaluronic acid for the treatment of symptomatic osteoarthritis of the hip: A double-blind, randomized pilot study.
        Orthop J Sports Med. 2021; 9 (2325967120969210)
        • Villanova-López M.M.
        • Núñez-Núñez M.
        • Fernández-Prieto D.
        • et al.
        Randomized, double-blind, controlled trial, phase III, to evaluate the use of platelet-rich plasma versus hyaluronic acid in hip coxarthrosis.
        Rev Esp Cir Ortop Traumatol. 2020; 64: 134-142
        • Battaglia M.
        • Guaraldi F.
        • Vannini F.
        • et al.
        Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis.
        Orthopedics. 2013; 36: e1501-e1508
        • Coleman B.D.
        • Khan H.M.
        • Maffulli N.
        • Cook J.L.
        • Wark J.D.
        Studies of surgical outcome after patellar tendinopathy: Clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group.
        Scand J Med Sci Sports. 2000; 10: 2-11
        • Kellgren J.H.
        • Lawrence J.S.
        Radiological assessment of osteo-arthrosis.
        Ann Rheum Dis. 1957; 16: 494-502
        • Cross M.
        • Smith E.
        • Hoy D.
        • et al.
        The global burden of hip and knee osteoarthritis: Estimates from the global burden of disease 2010 study.
        Ann Rheum Dis. 2014; 73: 1323-1330