Abstract：
OBJECTIVE: To assess the efficacy of intra-articular viscosupplementation as a therapeutic intervention for hip osteoarthritis (OA), as well as to assess the duration of efficacy, effect of dose, composition and number of injections of the viscosupplement, and the incidence of adverse effects.
METHODS: We performed a systematic review using the literature search from the following databases: Embase, Medline, PubMed, Web of Science, and Scopus. Quality assessment of the included studies was performed using the Modified Newcastle-Ottawa Quality Assessment Scale. Random-effects meta-analysis and mixed-effects subgroup analysis were carried out, but due to the high heterogeneity, low level of evidence, and high risk of bias of the included studies after analyzing the data, weighted means and pooled estimates have not been provided. Instead, we have provided a subjective synthesis of the results.
RESULTS: Forty studies were included in the analysis from an initial search of 3,265 studies, with data from a total of 3,350 patients. The level of available evidence was low with an overall high risk of bias. Nearly all studies showed a reduction in mean pain at 1 month, 3 months, and 6 months of follow-up, as well as at the end point, and an improvement in mean patient-reported function was also seen at these time points. However, heterogeneity was extremely high at all time points and remained despite attempts at removing outliers. Subgroup analyses looking at the effects of dose, volume, composition of viscosupplement, and number of injections were carried out, but substantial heterogeneity still remained. There were no lasting adverse effects.
CONCLUSIONS: Weak evidence suggests that viscosupplementation improves patient-reported pain and function at end point compared to baseline, regardless of dose, volume, composition, and number of injections. However, due to the high heterogeneity, low level of evidence, and high risk of bias in the current available literature, the strength of our conclusions is limited.
METHODS: Level IV, systematic review of level I to IV studies.
METHODS: We performed a systematic review using the literature search from the following databases: Embase, Medline, PubMed, Web of Science, and Scopus. Quality assessment of the included studies was performed using the Modified Newcastle-Ottawa Quality Assessment Scale. Random-effects meta-analysis and mixed-effects subgroup analysis were carried out, but due to the high heterogeneity, low level of evidence, and high risk of bias of the included studies after analyzing the data, weighted means and pooled estimates have not been provided. Instead, we have provided a subjective synthesis of the results.
RESULTS: Forty studies were included in the analysis from an initial search of 3,265 studies, with data from a total of 3,350 patients. The level of available evidence was low with an overall high risk of bias. Nearly all studies showed a reduction in mean pain at 1 month, 3 months, and 6 months of follow-up, as well as at the end point, and an improvement in mean patient-reported function was also seen at these time points. However, heterogeneity was extremely high at all time points and remained despite attempts at removing outliers. Subgroup analyses looking at the effects of dose, volume, composition of viscosupplement, and number of injections were carried out, but substantial heterogeneity still remained. There were no lasting adverse effects.
CONCLUSIONS: Weak evidence suggests that viscosupplementation improves patient-reported pain and function at end point compared to baseline, regardless of dose, volume, composition, and number of injections. However, due to the high heterogeneity, low level of evidence, and high risk of bias in the current available literature, the strength of our conclusions is limited.
METHODS: Level IV, systematic review of level I to IV studies.
摘要：
目的：本研究的目的是评估关节内黏液补充作为髋关节骨关节炎（OA）治疗干预的疗效，以及评估疗效的持续时间，剂量的影响，粘胶补充剂的成分和注射次数，以及不良反应的发生率。
方法：我们使用以下数据库的文献检索进行了系统综述：Embase，Medline,Pubmed,WebofScience和Scopus使用改良的纽卡斯尔-渥太华质量评估量表对纳入的研究进行质量评估。进行随机效应荟萃分析和混合效应亚组分析，但是由于高度的异质性，在分析数据后，纳入研究的证据水平低，偏倚风险高，尚未提供加权平均数和汇总估计数。相反，我们提供了结果的主观综合。
结果：从最初的3265项研究中，分析了40项研究，数据来自总共3350名患者。现有证据水平较低，总体偏倚风险较高。几乎所有的研究都显示在1个月时平均疼痛减少，3个月和6个月随访,以及在端点，在这些时间点,患者报告的平均功能也有改善.然而,异质性在所有时间点都非常高，尽管试图消除异常值，但仍然存在。亚组分析观察剂量的影响，volume,进行了粘胶补充剂的组成和注射次数，但仍然存在很大的异质性。没有持久的不良反应。
结论：微弱的证据表明，与基线相比，粘胶补充剂可改善患者报告的终点疼痛和功能，不管剂量，volume,成分和注射次数。然而,由于高度的异质性，现有文献中证据水平低，偏倚风险高，我们结论的力量是有限的。I-IV级研究的系统评价证据水平：IV。
方法：我们使用以下数据库的文献检索进行了系统综述：Embase，Medline,Pubmed,WebofScience和Scopus使用改良的纽卡斯尔-渥太华质量评估量表对纳入的研究进行质量评估。进行随机效应荟萃分析和混合效应亚组分析，但是由于高度的异质性，在分析数据后，纳入研究的证据水平低，偏倚风险高，尚未提供加权平均数和汇总估计数。相反，我们提供了结果的主观综合。
结果：从最初的3265项研究中，分析了40项研究，数据来自总共3350名患者。现有证据水平较低，总体偏倚风险较高。几乎所有的研究都显示在1个月时平均疼痛减少，3个月和6个月随访,以及在端点，在这些时间点,患者报告的平均功能也有改善.然而,异质性在所有时间点都非常高，尽管试图消除异常值，但仍然存在。亚组分析观察剂量的影响，volume,进行了粘胶补充剂的组成和注射次数，但仍然存在很大的异质性。没有持久的不良反应。
结论：微弱的证据表明，与基线相比，粘胶补充剂可改善患者报告的终点疼痛和功能，不管剂量，volume,成分和注射次数。然而,由于高度的异质性，现有文献中证据水平低，偏倚风险高，我们结论的力量是有限的。I-IV级研究的系统评价证据水平：IV。
