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 profile 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 (PRISMA) 2020 guidelines (PROSPERO: 1332326). A search was performed without date restriction. Eligible studies included randomized control trials spell and cohort studies enrolling adults who have hip OA receiving intra-articular CSI versus any comparator. Risk of bias was assessed using the Cochrane Risk of Bias tool, version 2 (RoB 2) and the Risk Of Bias In Non-randomized Studies - of Interventions tool (ROBINS-I). A narrative synthesis was the primary approach; secondary random-effects meta-analyses were performed for short-term pain (less than three to six months post-operatively), medium- to long-term pain (over six months post-operatively), and short-term physical function where data permitted. There were 14 studies (n = 3,235) included: nine RCTs and five observational studies. There was no study that achieved low overall risk of bias.

Corticosteroid injection demonstrated consistent short-term analgesic benefit, with meta-analytic pooling of a limited number of studies yielding a large effect for pain (Hedges' g = 0.92, 95% confidence interval (CI) 0.40 to 1.44, I² = 44.8%) and function (g = 0.86, 95% CI 0.54 to 1.17, I² = 0%) within three months. Pain effects over six to 12 months were non-significant (g = 0.10, 95% CI 0.20 to 0.40). Ultrasound-confirmed synovitis was a strong predictor of treatment response. Rapidly progressive OA occurred in approximately 7.0% of patients in the largest cohort (n = 1,471), and was associated with advanced baseline radiographic severity.

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