Strong evidence supports the use of intraarticular corticosteroids to improve function and reduce pain in the short-term for patients with symptomatic osteoarthritis of the hip.


Three high quality studies (Lambert et al, Atchia et al , Qvistgaard et al ) compared IA injection of corticosteroids with placebo and showed statistically significant improvement in pain and function scores. Significant benefits from IA corticosteroid injection were present 3 months (Lambert et al ) and 8 weeks (Atchia et al ) after treatment compared to placebo.

Atchia et al and Qvistgaard et al also compared IA injection of hyaluronic acid (HA) to corticosteroid and placebo in the same aforementioned studies. While these studies demonstrated improved pain and function with IA corticosteroid, they both failed to show significant difference between the performance of HA and placebo. In addition, single IA injection of HA for the treatment of symptomatic (VAS pain score >40mm) moderate hip OA (Kellgren Lawrence grades 2 and 3) failed to demonstrate significant improvement compared to placebo in another high quality study (Richette et al for function, stiffness and pain at 3 months. Other high quality studies investigating HA for the treatment of symptomatic hip OA discovered in this search compared the performance of IA injections of different formulations of HA (Bekerom 2008, Tikiz et al , IA injection of corticosteroids (Spitzer et al), and IA injection of anesthetic (Migliore et al), but did not test against a placebo.

No high quality randomized controlled trials were available comparing the performance of IA injection of stem cells or prolotherapy to placebo. Three studies (Battaglia et al , Dallari et al) compared IA injections of platelet-rich plasma (PRP) versus HA or a combination of PRP and HA. However, no high quality studies comparing PRP with placebo were available for inclusion in our analysis.

  1. Lambert,R.G.; Hutchings,E.J.; Grace,M.G.; Jhangri,G.S.; Conner-Spady,B.; Maksymowych,W.P. Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum.; 2007/7: 7
  2. Atchia,I.; Kane,D.; Reed,M.R.; Isaacs,J.D.; Birrell,F. Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis. Ann Rheum.Dis; 2011/1: 1
  3. Qvistgaard,E.; Christensen,R.; Torp-Pedersen,S.; Bliddal,H. Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline. Osteoarthritis Cartilage; 2006/2: 2
  4. Bekerom,M.P.J.; Rys,B.; Mulier,M. Viscosupplementation in the hip: Evaluation of hyaluronic acid formulations. Arch.Orthop.Trauma Surg.; 2008: 3
  5. Tikiz,C.; Unlu,Z.; Sener,A.; Efe,M.; Tuzun,C. Comparison of the efficacy of lower and higher molecular weight viscosupplementation in the treatment of hip osteoarthritis. Clin Rheumatol.; 2005/6: 3
  6. Spitzer,A.I.; Bockow,B.I.; Brander,V.A.; Yates,J.W.; Maccarter,D.K.; Gudger,G.K.; Haller,S.; Lake,S.L.; Magilavy,D.B. Hylan g-f 20 improves hip osteoarthritis: a prospective, randomized study. Phys Sportsmed.; 2010/6: 2
  7. Migliore,A.; Massafra,U.; Bizzi,E.; Vacca,F.; Martin-Martin,S.; Granata,M.; Alimonti,A.; Tormenta,S. Comparative, double-blind, controlled study of intra-articular hyaluronic acid (Hyalubrix) injections versus local anesthetic in osteoarthritis of the hip. Arthritis Res Ther; 2009: 6
  8. Battaglia,M.; Guaraldi,F.; Vannini,F.; Rossi,G.; Timoncini,A.; Buda,R.; Giannini,S. Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis. 2013/12: 12
  9. Dallari,D.; Stagni,C.; Rani,N.; Sabbioni,G.; Pelotti,P.; Torricelli,P.; Tschon,M.; Giavaresi,G. Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study. Am J Sports Med; 2016/3: 3