CLINICAL QUESTION

Which intra-articular injections are most effective in adults with degenerative joint disease of the hip?

BOTTOM LINE

In the network meta-analysis, only steroid injections provided short-term (but not long-term) improvement in pain. No injection provided statistically significant improvements in function. (Level of Evidence = 1a−)

SYNOPSIS

The authors searched multiple databases and registries to identify randomized trials of intra-articular injections for patients with degenerative joint disease of the hip. They included 16 trials with 1,809 patients. The trials evaluated hyaluronic acid, platelet-rich plasma, hyaluronic acid plus platelet-rich plasma, steroids, anesthetic, steroid plus anesthetic, and placebo, although, not all trials included a placebo arm. Two studies were at high risk of bias; the others were at low risk of bias. The authors conducted a network meta-analysis to model comparative effectiveness of the various injections. They reported that after 3 months, pain on a 10-point visual analog scale (a change of 1.5 to 2 is clinically meaningful) was significantly improved only for steroid injections compared with placebo (−1.64; 95% CI, −2.79 to −0.62). However, no injection improved pain more than placebo after 6 months. Function, as measured by the 100-point Western Ontario and McMaster Universities Osteoarthritis Index, was improved at 3 months and 6 months after injection, but these improvements were not statistically significant. The authors reported heterogeneity among the data. They reported no data on the potential harms of the injections.