Efficacy of Intra-Articular Corticosteroid Injection for Hip Osteoarthritis: A Systematic Review With Meta-Analysis

Intra-articular corticosteroid injection (CSI) is widely used for hip osteoarthritis (OA), yet its efficacy and safety remain incompletely characterized. The 2023 American Academy of Orthopaedic Surgeons guidelines assigned CSI a high-evidence, moderate-strength recommendation, underscoring the need for updated synthesis.

A systematic review and meta-analysis was conducted per Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines (PROSPERO: 1332326), with no date restriction on the search. Eligible studies included randomized controlled trials and cohort studies enrolling adults with hip OA receiving intra-articular CSI versus any comparator. Risk of bias was assessed using Risk of Bias 2 (randomized studies) and Risk Of Bias In Nonrandomized Studies-of Interventions tool (non-randomized studies). Narrative synthesis was the primary approach, with secondary random-effects meta-analyses for short-term pain less than three to six months), medium- to long-term pain (over six months), and short-term physical function where data permitted. Fourteen studies (n = 3,235; nine RCTs, five observational) were included; no study achieved low overall risk of bias.

CSI showed consistent short-term analgesic benefit, with pooled effects within three months large for both pain (Hedges' g = 0.92, 95% CI 0.40 to 1.44, I² = 44.8%) and function (g = 0.86, 95% CI 0.54 to 1.17, I² = 0%). Pain effects at 6 to 12 months were non-significant (g = 0.10, 95% CI -0.20 to 0.40). Ultrasound-confirmed synovitis strongly predicted treatment response. Rapidly progressive OA occurred in approximately 7.0% of patients in the largest cohort (n = 1,471), associated with advanced baseline radiographic severity.

Intra-articular corticosteroid injections produce large, clinically meaningful short-term pain relief and functional improvement in hip OA, but benefits are not reliably sustained beyond three months. A clinically relevant risk of rapidly progressive OA warrants careful patient selection. CSI should be used as a time-limited adjunct within a multimodal management strategy.