What is the evidence for corticosteroid injection to treat osteoarthritis of the femoral-acetabular (Hip) joint?
AMSTAR Rating
Summary
Patient Population:
5 single center RCTs. 346 total participants randomised, with 134 receiving hip intra-articular steroid injection.
These trials were conducted on participants with painful hip OA, including: those eligible or awaiting THA, those refractory to simple analgesia or any person meeting ACR criteria for OA of the hip.
Intervention:
Any steroid preparation at any dose. Included were methylprednisolone acetate (120mg, 40mg), triamcinolone acetonide (80mg)and triamcinolone hexacetonide (20mg)
Comparison:
Saline, bupivacaine, bupivacaine + saline, mepivacaine, hyalgan, durolane + lidocaine, saline + lidocaine and standard care (no injection).
Outcome:
All studies had patient reported pain as a primary outcome, however a variety of measures were used. Overall effect on pain was calculated from three studies which reported continuous scales for pain measurement. Four studies included some form of function assessment. Four studies reported safety data.
- Primary Outcome: Self-Reported Pain
- Difference was not significant at the 0.05 level (SMD = −1.90; 95% CI: −4.07 to 0.26; P= 0.08).
- Secondary Outcome: Function
- 3 of 4 studies that assessed function noted a statistically significant improvement in function
- Secondary Outcome: Safety
- Injection procedure was noted to be well tolerated, two trials reported no adverse events, one trial reported equal adverse events in both groups that were mild or unrelated to treatment, and one study noted 3 patients had a post-injection pain flare but did not say which group they belonged to
- One serious adverse event, a deep venous thrombosis was reported 3 months post injection in the steroid group.
Guideline Recommendations
| Source | Recommendation |
|---|---|
| AAOS (2017) | Strong evidence to support use |
| OARSI (2008) | Option for refractory moderate to severe Pain |
| ACR (2019) | Strong evidence for image guided injection |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Pain
Self report
Function
3 of 4 studies
Safety
General
Participant Information
their were 346 people.
their were 5 studies used.
