Hip osteoarthritis is a common joint condition that can cause pain, stiffness, reduced mobility, and some difficulty with everyday activities. It develops when the cartilage inside the hip joint gradually breaks down, leading to inflammation, joint space narrowing, and changes in how the hip moves.
Because hip osteoarthritis can affect walking, exercise, sleep, and overall quality of life, researchers continue to study nonsurgical treatment options that may help manage symptoms and support joint function. One area of growing interest is the use of orthobiologics, including platelet-rich plasma, also known as PRP.
In this systematic review and meta-analysis published in Frontiers in Bioengineering and Biotechnology, researchers compared PRP alone with PRP combined with hyaluronic acid, or HA, for patients with hip osteoarthritis. The goal was to better understand whether adding HA to PRP provides additional benefit for pain relief and function.
What Are PRP and Hyaluronic Acid?
Platelet-rich plasma is made from a patient’s own blood. A blood sample is processed to concentrate platelets, which contain growth factors and signaling molecules involved in healing, inflammation regulation, and tissue repair.
PRP is commonly studied in orthopedic and regenerative medicine because it may help:
- Support tissue repair signaling
- Regulate inflammation
- Improve the joint environment
- Reduce pain
- Support mobility and function
Hyaluronic acid is a naturally occurring substance found in joint fluid. It helps lubricate the joint, reduce friction, and support smoother movement. In osteoarthritis, the concentration and quality of hyaluronic acid in the joint can decrease, which may contribute to stiffness, pain, and reduced joint comfort.
Because PRP and HA work through different mechanisms, researchers have explored whether combining them may provide stronger benefits than PRP alone.
Study Overview
This review analyzed studies comparing intra-articular PRP injections alone with PRP plus HA injections for hip osteoarthritis. Intra-articular means the treatment is injected directly into the joint space.
The researchers searched major scientific databases and included 3 studies in the final analysis. These included:
- 2 randomized controlled trials
- 1 cohort study
- 190 total patients
- 88 patients who received PRP plus HA
- 102 patients who received PRP alone
The studies followed patients over different time points, including 3, 6, and 12 months. Researchers compared pain scores and functional outcomes to evaluate whether one approach performed better than the other.
Key Findings From the Review
The main finding was that PRP alone appeared to perform better than PRP plus HA for pain outcomes at certain time points.
Compared with PRP alone, the combination of PRP and HA was associated with higher pain scores at 3 months and 12 months. At 6 months, pain scores were similar between the two groups.
When researchers looked at functional outcomes, they found no statistically significant difference between PRP alone and PRP plus HA at 3, 6, or 12 months.
In simpler terms, adding HA to PRP did not appear to improve hip function in the studies reviewed. For pain, PRP alone showed more favorable results at the 3-month and 12-month follow-ups.
Why PRP Alone May Be Worth Studying Further
PRP continues to be an important focus in regenerative medicine because of its biological signaling properties. Platelets release growth factors and other molecules that may help regulate inflammation and support tissue repair activity within the joint.
For hip osteoarthritis, PRP may help influence the joint environment by:
- Supporting anti-inflammatory signaling
- Encouraging repair-related pathways
- Helping reduce pain
- Improving joint comfort
- Supporting activity and mobility
This review does not suggest that all patients respond the same way, but it does support continued interest in PRP as a nonsurgical option being studied for hip osteoarthritis.
Why Adding HA Did Not Show Added Benefit
The idea behind combining PRP with HA is reasonable. PRP may provide growth factors and repair signals, while HA may help improve lubrication and reduce friction within the joint. In theory, combining the two could create a stronger overall effect.
However, in this review, adding HA did not provide additional improvement compared with PRP alone. The authors noted that the results may have been influenced by several factors, including:
- Differences in PRP preparation
- Differences in HA molecular weight
- Variation in injection protocols
- Different follow-up periods
- Differences in osteoarthritis severity
- Small number of available studies
This is an important point because orthobiologic treatments can vary greatly depending on how they are prepared and delivered. More standardized research may help clarify which patients benefit most and which treatment protocols are most effective.
Pain and Function: What the Study Suggests
One of the clearest findings from the review was that PRP alone was favored for pain outcomes at 3 and 12 months. This suggests that PRP may have a meaningful role in supporting pain management for some patients with hip osteoarthritis.
However, functional scores did not significantly differ between PRP alone and PRP plus HA. Hip function can be influenced by many factors, including:
- Severity of joint degeneration
- Cartilage loss
- Joint stiffness
- Muscle strength
- Mobility limitations
- Activity level
- Overall health
Because of this, improving pain does not always mean function will improve at the same rate. This may be especially true in patients with more advanced structural changes in the hip joint.
Why This Research Matters
Hip osteoarthritis can be difficult to manage, especially for patients who want to delay surgery or explore nonsurgical options. Orthobiologics such as PRP continue to be studied because they may help support the joint environment without relying only on pain medication or more invasive procedures.
This review is helpful because it compares two practical approaches: PRP alone and PRP combined with HA. While the combination may seem promising in theory, the findings suggest that adding HA may not provide extra benefit for hip osteoarthritis based on the studies currently available.
The review also reinforces the need for better standardization in regenerative medicine research. PRP can vary depending on platelet concentration, leukocyte content, centrifugation method, dose, and injection schedule. HA can also vary by molecular weight and formulation. These differences matter because they may affect patient outcomes.
A Growing Area of Orthopedic Regenerative Medicine
Platelet-rich plasma remains an important area of research for orthopedic and regenerative medicine. Its ability to deliver concentrated growth factors and biological signals makes it a promising option for joint-related conditions such as hip osteoarthritis.
This review found that PRP alone showed more favorable pain outcomes than PRP combined with HA at certain follow-up points, while functional outcomes were similar between groups. Although more high-quality studies are needed, the findings suggest that PRP may continue to play an important role in nonsurgical hip osteoarthritis research.
As future studies improve treatment standardization and include larger patient groups, researchers may be better able to determine which PRP protocols work best and which patients are most likely to benefit.
Source Santiago MS, Doria FM, Morais Sirqueira Neto J, Fontes FF, Porto ES, Aidar FJ, Silva MVVMP, Cavalcante DVS, Akbarpoor F, Zamora FV, Souza DT, Madruga RETTA, Díaz-de-Durana AL, Merino-Fernandez M, Cipolotti R. Platelet-rich plasma with versus without hyaluronic acid for hip osteoarthritis: a systematic review and meta-analysis. Front Bioeng Biotechnol. 2025 Mar 24;13:1545431. doi: 10.3389/fbioe.2025.1545431. Available from: https://www.frontiersin.org/journals/bioengineering-and-biotechnology/articles/10.3389/fbioe.2025.1545431/full
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