Intra-Articular Steroid Injection for Patients with Hip Osteoarthritis: A Systematic Review and Meta-Analysis
Table 1
Characteristics of included trials.
Author/year
Study design (level of evidence)
Sample size (steroid/control)
Age (mean ± SD, years) (no. of males/females)
Follow-up, weeks
Loss to follow-up (steroid/control)
Inclusion criteria
Injection
Guidance
Atchia/2011
RCT Steroid/HA/PLB (2)
38 (19/19)
PLB: 70 ± 10 (7/12) Steroid: 67 ± 7 (11/8)
1, 4, 8
Before week 8: 0/0 Week 8: 0/1
(1) Aged over 50 years (2) Primary unilateral hip OA (3) Pain duration was more than a month or listed for elective THR
Single injection: PLB: 3 ml NS; steroid: 3 ml/120 mg Depo-Medrone
Ultrasound
Kullenberg/2004
RCT Steroid/LA (2)
80 (40/40)
Local analgesic: 72.7 ± 6.4 Steroid: 67.3 ± 7.7
3, 12
Before week 12: NA Week 12: 40/40
(1) Pain duration of more than 4 weeks and pain of VAS score > 3 (2) Ahlbäck grade was 2 or worse and joint space narrowing with cartilage destruction of 50% or worse
Single injection: steroid: 80 mg TAC; local analgesic: 1% mepivacaine
Fluoroscopy
Lambert/2007
RCT Steroid/placebo (2)
52 (31/21)
PLB: 56.9 ± 11(11/10) Steroid: 65.6 ± 11(10/21)
4, 8, 12
Week 8: 0/2 Week 12: 11/15 Week 24: 15/18
(1) Aged above 40 years (2) Hip OA as defined by the ACR criteria and radiographic changes (3) Symptoms lasted for at least 6 months (4) Resistance to conventional therapy
Single injection: PLB: 2 ml NS + 10 mg bupivacaine; steroid: 40 mg THA + 10 mg bupivacaine
Fluoroscopy
Qvistgaard/2006
RCT Steroid/HA/placebo (2)
68 (32/36)
PLB: 64 ± 11(14/22) Steroid: 69 ± 9(9/23)
2, 4, 12
Week 4: 2/1 Week 12: 6/3
(1) Aged above 18 years (2) Hip OA as defined by the ACR criteria and radiographic changes (3) Stable medication for at least 3 weeks before inclusion
Three injections with 14-day intervals: PLB: 2 ml NS; steroid: 1 ml/40 mg Depo-Medrone, followed by two sham injections
Ultrasound
Micu/2010
Case-control trial (3)
61 (40/21) 40 patients with 45 hips
62.78 ± 8.16
12
NA
(1) Hip OA with synovitis as defined by the ACR criteria (2) Refractory to conventional therapy for 2 months
8 mg of betamethasone, 2 ml of lidocaine 1%, and 0.5 ml of air
Single injection: LA: 10 ml bupivacaine 0.5%; steroid: 10 ml of bupivacaine plus 20 mg of triamcinolone; NS: 10 ml of normal saline
X-ray
Margules/2001
Case-series trial (4)
510
NA
NA
NA
(1) Patients who did not experience improvement with analgesics or physical therapy (2) Patients who could not tolerate surgery
40 mg/cm3 of TAC
Fluoroscopy
Deshmukh/2011
Retrospective case-series trial (4)
217
NA
2
NA
Patients with a clinical diagnosis of hip OA (Kellgren–Lawrence scale)
5 ml of 0.5% bupivacaine and 1 ml (80 mg) MP
Fluoroscopy
Robinson/2007
Nonrandomized controlled cohort trial (3)
40 mg: 75
40 mg: 63.28 (15/60)
12
NA
Patients with a clinical diagnosis of hip OA (Kellgren–Lawrence scale) and symptoms with duration greater than 4 months
40 mg or 80 mg MP and 3–4 ml 0.5% bupivacaine
Fluoroscopy
80 mg: 45
80 mg: 65.64 (15/30)
Subedi/2015
Observational study (2)
100
58 (36/64)
6–8
NA
NA
80 mg MP (Depo-Medrone) and 10 ml bupivacaine
Fluoroscopy
Walter/2019
Retrospective case-series trial (4)
113
59 ± 13.7 (36/77)
24
13
Patients with radiographic hip osteoarthritis
80 mg (or 40 mg) of triamcinolone (40 mg/ml) and 3 ml (or 4 ml) of 0.5% ropivacaine
Ultrasound or fluoroscopy
Young/2012
Controlled cohort trial (3)
Low volume: 55 High volume: 55
Low volume: 62 (27/32) High volume: 68 (19/40)
12
Low volume: NA High volume: 6
NA
Low volume: 40 mg triamcinolone and 2 ml bupivacaine High volume: additional 6 ml of sterile water
Fluoroscopy
SD: standard deviation; RCT: randomized controlled trial; HA: hyaluronic acid; PLB: placebo; OA: osteoarthritis; NS: normal saline; VAS: visual analog scale; TAC: triamcinolone acetonide; ACR: American College of Rheumatology; THA: triamcinolone hexacetonide; NA: not available; THR: total hip replacement; LA: local analgesia; MP: methylprednisolone. The level of evidence of each study was rated on the basis of Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.
