The efficacy of intra-articular steroids in hip osteoarthritis: A systematic review

OBJECTIVE: International guidelines recommend intra-articular steroid injections (IASI) in the management of hip osteoarthritis (OA), though these recommendations are extrapolated primarily from studies of knee OA. The aim of this systematic review was to assess the efficacy of IASI on pain in patients with hip OA. METHODS: MEDLINE, EMBASE, AMED, CINAHL Plus, Web of Science and the Cochrane Central Register of Controlled Trials were searched from inception to May 2015. Randomised controlled trial assessing the efficacy of hip IASI on pain were included. Pre-specified data was independently extracted by two reviewers using a standardised form. Quality assessment was performed using the Jadad scoring system. RESULTS Five trials met the inclusion criteria, all of which had a small number of participants (≤101). All studies reported some reduction in pain at 3-4 weeks post-injection compared to control. Based on data from individual trials the treatment effect size was large at 1 week post-injection but declined thereafter. A clinically significant (moderate effect size) reduction in pain was reported in 2 trials up to 8 weeks following IASI. Pooled results of 2 trials showed an increase likelihood of meeting the OMERACT-OARSI response criteria at 8 weeks post-injection, odds ratio 7.8 (95% CI 2.7-22.8). The number needed to treat to achieve one OMERACT-OARSI responder at 8 weeks post-injection was 2.4 (95% CI 1.7-4.2). CONCLUSIONS: Hip IASI appears to be efficacious in short term pain reduction in those with hip OA. Further research is required to confirm longer term efficacy and evaluate safety.