Pain management of hip osteoarthritis with corticosteroids vs injection therapies: a systematic review and meta-analysis

Abstract

Introduction: Osteoarthritis (OA) is the most common degenerative joint disease, characterized by chronic pain and articular cartilage damage. Hip OA is characterized by the progressive breakdown of articular cartilage within the hip, particularly the hip joints ball and socket structure, Hip OA leads to joint pain, stiffness and causes functional limitations.

Aim: To analyse the effectiveness of intra-articular corticosteroids (IA CS) use against other injection therapies for the symptomatic management of hip OA.

Methods: PROSPERO registered-CRD42024526221. Medline, Embase, Scopus and Web of Science were searched for trials.

Inclusion criteria: Adults with symptomatic hip OA, randomised trials for treatment of hip OA with IA injection methods. Studies must involve comparators and the outcome measure must include a measurement of pain such as Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) or the visual analogue scale (VAS). Cochrane risk of bias and JBI critical appraisal tools assessed risk of bias. RevMan was used for creation of statistical figures within the meta-analysis.

Results: Data extracted in the systematic review presented improvements on pain, function, stiffness, and overall scores using WOMAC and VAS scales. However, data from the meta-analysis indicates that there is no statistical significance (significance is a p value < 0.05) between corticosteroids and placebo or hyaluronic acid (HA). Meta-analyses produced p values of 0.05 when comparing CS and placebo WOMAC pain scores at 2 months, CS and HA overall WOMAC at 6 months-p value of 0.46. WOMAC stiffness and function scores between CS and placebo at 2 months-p value of 0.05 and 0.08, thus statistically insignificant.

Conclusion: This meta-analysis shows that IA corticosteroid injections for hip OA don't provide statistically significant symptomatic improvement for patients compared to placebo. Showing the urgent need to assess other therapies in hip OA treatment.

Fig. 1

Summary of search results and trial selection

Fig. 2

WOMAC pain score forest plot at 2 months post injection [46, 48]

Fig. 3

Overall WOMAC score forest plot at 6 months post injection [49, 52]

Fig. 4

WOMAC function score forest plot at 2 months post injection [46, 48]

Fig. 5

WOMAC stiffness score forest plot at 2 months post injection [46, 48]