Combined ultrasound-guided hyaluronic acid injections, high-power laser therapy and physiotherapy improve hip function in osteoarthritis: A randomized controlled trial.

Abstract

High-power laser therapy (HPLT) is effective in treating musculoskeletal conditions, reducing pain and improving joint functionality. This randomized controlled trial (RCT) aimed to explore the effectiveness of a combination of HPLT, hyaluronic acid injections and rehabilitation for patients with hip osteoarthritis (OA). This RCT enroled adults over 18 with a diagnosis of hip OA (Stages 1-3) who experience hip pain of 4 or higher on a scale. Participants must have a body mass index (BMI) under 30. Patients were randomly assigned to either a study or control group, with both patients and assessors blinded to the treatment. The study group received hyaluronic acid injections, physiotherapy and active HPLT, while the control group received the same management, except for sham HPLT. We used the Harris Hip Score (HHS) as primary outcome to assess hip functioning, and as secondary outcomes the following ones: Numeric Rating Scale (NRS) for pain, EuroQol-5 Dimension (EQ-5D) for quality of life and the 6-Minute Walking Test for physical performance. Evaluations were conducted at multiple time points: baseline (T0), post-treatment (T1) and follow-ups at 3 months (T2), 6 months (T3) and 12 months (T4) after the first visit. Moreover, 57 patients were randomly assigned to either a study group (<i>n</i> = 28) or a control group (<i>n</i> = 29). Both groups showed significant initial improvements in HHS from T0 to T1 (<i>p</i> < 0.001). However, statistically significant intergroup differences favouring the study group were found for the 6-Minute Walk Test (<i>p</i> = 0.029) and the EuroQoL at T3 (<i>p</i> = 0.030). This RCT demonstrated that hyaluronic acid injections and physiotherapy, combined with laser therapy, improve hip function and pain perception in hip OA patients. While laser therapy showed promise, more evidence is needed. Level I.