Intra-Articular Steroid Injection for Patients with Hip Osteoarthritis: A Systematic Review and Meta-Analysis

Table 2

Results of the included trials.

Author/year	Pain outcome extracted	Hip pain			Side effects	Potential predictors	Conclusion
		Baseline	Short term <8 weeks	Long term ≥8 weeks
Atchia/2011	NRS: worst pain^#	Placebo: 6.55 ± 0.68; Steroid: 5.99 ± 0.62	1 week: placebo: 5.9 ± 0.96; steroid: 3.06 ± 1.2 (); 4 weeks: placebo: 6.42 ± 1.08; steroid: 3.89 ± 1.39 ()	8 weeks: placebo: 6.98 ± 0.89; steroid: 5.06 ± 1.23 ()	NA	(1) Synovitis; (2) Changes in medications	(1) IAST is highly efficacious in pain relief; (2) Synovitis is the single predictor in weeks 4 and 8; (3) No differences between NSAIDs and paracetamol or paracetamol/weak opioid groups during the trial
Kullenberg/2004	Total VAS	Placebo: NA; Steroid: 12.2 ± 2.2	3 weeks: placebo: 12 ± 1; steroid: 3.8 ± 2.6 ()	12 weeks: placebo: 12.4 ± 1.8; steroid: 7.9 ± 3.9 ()	NA	NA	IAST might improve pain and range of motion
Lambert/2007	WOMAC pain scores	Placebo: 314.3 ± 76.2; Steroid: 310.1 ± 54.6	1 month: placebo: 276.4 ± 129; steroid: 149.6 ± 113 ()	2 months: placebo: 306.5 ± 121.2; steroid: 157.4 ± 127.2 ()	One deep vein thrombosis at 3 months in the steroid group; one patient in the placebo group and 3 patients in the steroid group reported rebound pain	(1) Age; (2) Severity of hip OA	(1) IAST is an effective treatment in pain relief; (2) The efficacy of IAST remained significant with age as a covariate; (3) No association between the severity of OA and the responder status
Qvistgaard/2006	VAS (walking pain)^#	Placebo: 42.4 ± 19.17; Steroid: 44.0 ± 19.17	2 weeks: placebo: 45.52 ± 19.17; steroid: 32.38 ± 19.17 (); 4 weeks: placebo: 42.51 ± 19.17; steroid: 29.52 ± 19.17 ()	12 weeks: placebo: 38.32 ± 19.17; steroid: 35.85 ± 19.17 ()	NA	(1) Degree of OA; (2) Effusion in the joint; (3) Age	(1) IAST provided significant improvement in pain within 3 mo; (2) Not related to the severity of OA, effusion in the joint, and age
Micu/2010	VAS (walking pain)	Control: 8.66 ± 0.79; Steroid: 8.17 ± 0.86	1 month: control: NA; steroid: 2.77 ± 0.79 ( vs. baseline)	3 months: control: 7.02 ± 0.53; steroid: 3.66 ± 0.79 ( vs. baseline)	Transient facial rash was present in 16 patients during the first 24–48 h after injection	Severity of synovitis	(1) IAST is an efficacious and safe treatment in pain relief; (2) Severity of synovitis was not significantly related to pain relief
Flanagan/1988	Grades 1–5	NA	Positive responders: week 4: 9	Positive responders: week 8: 4; week 24: 3; week 36: 2; week 48: 1	NA	(1) Severity of OA; (2) Time of the symptoms was present; (3) Concentric type of arthritis	(1) The patients had good pain relief within months but not longer than 1 year; (2) Patients with severer symptoms had a longer response; (3) Concentric type of arthritis does not respond to IAST
Margules/2001	NA	NA	NA	Pain relief responders: week 8: severe group: 9% (21/234); moderate group: 58% (131/226); mild group: 90% (46/51)	NA	Severity of OA	(1) IAST is an efficacious and safe treatment in pain relief; (2) Patients with a slighter grade severity of OA had a higher positive responder rate on pain relief
Deshmukh/2011	VAS	Positive responders: 150	Positive responders: 15–20 min: 148; week 2: 155	NA	NA	(1) Severity of OA; (2) Gender and age	(1) Pain relief following IAST related to radiographic severity of OA; (2) Neither gender nor age was a predictor
Robinson/2007	WOMAC pain scores	40 mg: 12 (2–20); 80 mg: 12 (2–20)	6 weeks: 40 mg: 10 (1–20) (); 80 mg: 8 (1–20) ()	12 weeks: 40 mg: 12 (1–20) (); 80 mg: 10 (1–20) ()	NA	(1) Dose; (2) Stiffness at baseline; (3) BMI; (4) Severity of OA	(1) The 80 mg dose had longer efficacy in week 12; (2) The responders had less stiffness at baseline; (3) Not associated with BMI and severity of OA
Subedi/2015	OHS	NA	NA	Positive responders: 82 (all grades of osteoarthritis)	NA	Severity of OA	IAST is a highly effective therapeutic measure for hip osteoarthritis across all grades of disease severity
Walter/2019	EQ5D-VAS	0	<8 weeks: Δ in EQ5D-VAS: 1 ± 18.32 ()	≥8 weeks: Δ in EQ5D-VAS: 0.25 ± 20.58 ()	NA	(1) Days from injection to surgery; (2) Dose, sex, short/long-term follow-up, age, and BMI	(1) No improvements in pain at short- and long-term intervals up to 6 months; (2) Positive correlation with the number of days to surgery and patient-reported outcomes; (3) Not related to dose, sex, age, and BMI
Young/2012	WOMAC pain scores	Low volume: 12.2; High volume: 12.3	NA	3 months’ Δ in pain: low volume: 8.8 (−28%); high volume: 8.9 (−28%)	One episode of temporary hyperglycaemia in a type 1 diabetic, one facial flush, one patient reported soft-tissue swelling, and two patients reported a temporary increase in pain	Injection volume	IAST is an effective therapeutic measure across volume of 3–12 ml

NRS: numerical rating scale; NA: not available; IAST: intra-articular steroid therapy; NSAIDs: nonsteroid anti-inflammatory drugs; VAS: visual analog scale; OA: osteoarthritis; WOMAC: Western Ontario and McMaster Universities Arthritis Index; US: ultrasound; BMI: body mass index; EQ5D-VAS: EuroQol 5-domain visual analog scale; OHS: the Oxford hip score; Δ: change from baseline. ^#The pain score data were extracted from the accompany graph in the included studies.