The MONOVISC Hip Osteoarthritis Study

Inclusion Criteria: * Male or female ≥ 30 years old * Body Mass Index (BMI) ≤ 35 * Clinical or radiographic diagnosis of hip osteoarthritis in the target hip, with a Kellgren-Lawrence (K/L) grade of 2 or 3. * Walking pain NRS ≥ 4 and ≤ 8. * Willing to discontinue all pain medications (except rescue medication) for 7 days prior to the first study injection and for the duration of the study. * Willing to discontinue rescue medication for 48 hours prior to the first study injection. * Willing to discontinue rescue medication for 48 hours prior to all follow-up visits * Ability to tolerate acetaminophen (e.g. Tylenol). * Must be physically and mentally willing and able to comply with pre and post-treatment scheduled clinical and radiographic evaluations * Must voluntarily sign the Institutional Review Board approved Informed Consent Form. * Must agree not to initiate cannabis therapy during the trial study period. Exclusion Criteria: * Radiographic evidence of osteonecrosis in the target hip * NRS walking pain ≥ 3 the contralateral hip * Clinically diagnosed osteoarthritis in either knee resulting in walking pain greater than NRS 5. * Dependence on external stabilization for walking (e.g. cane, crutches, walker, etc.) * Pain associated with lower back disorders that cannot be differentiated from target hip pain * Major dysplasia or congenital abnormality * Diagnosis of fibromyalgia * Primary inflammatory arthropathy, or any other condition affecting the joint, including rheumatoid arthritis or gout in the target hip * Any musculoskeletal condition that could impede efficacy measurement of the target hip * Any major surgery, arthroplasty, or arthroscopy of the lower extremities in the past 6 months, or planned surgery during the study * Infection of the injection site area * Chronic skin disorders that could interfere with injection site evaluation * Patients with asthma who require systemic use of corticosteroids * Septic arthritis in any joint in the past 12 weeks * For all patients: known hypersensitivity to hyaluronan, lidocaine, or acetaminophen * For patients undergoing fluoroscopic injection guidance: known hypersensitivity to iodine-based fluoroscopic contrast agents, shellfish, or iodine * Intra-articular steroid injection of the target hip within the last 3 months or hyaluronan injection of the target hip within the last 26 weeks * Systemic corticosteroids within the last 12 weeks * Glucosamine and/or chondroitin sulfate within last 4 weeks * Currently on anticoagulation therapy, including aspirin therapy of \> 81 mg/day (e.g. one daily "baby aspirin"). * Uncontrolled diabetes mellitus. * Pregnant or breast feeding, or plan to be pregnant during the course of the study * Any significant illness (metastasis of any type) that decreases the probability of the subject's survival to the 26 week endpoint * Patients unwilling/unable to complete a pain/function and quality of life questionnaires * Significant trauma to the index hip within 26 weeks of screening * Is receiving workman's compensation, or is currently involved in litigation relating to hip osteoarthritis * Is receiving prescription pain medication for conditions unrelated to hip osteoarthritis * Chronic use of narcotics * Unwilling to return for follow-up visits as described in this protocol * Otherwise determined by the investigator to be medically unsuitable for participation in this study