Comparing the Efficacy and Safety of Intra-articular Injection Treatments for Hip Osteoarthritis: A Systematic Review and Network Meta-analysis

Background: Hip osteoarthritis is a debilitating condition that leads to progressive joint pain and stiffness. While total hip arthroplasty provides definitive treatment, intra-articular injections offer a less invasive alternative for patients. Several injection options are available, including corticosteroids (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP). Previous reviews and network meta-analyses have compared the short-term efficacy of these injections, but it remains unclear if a particular injection provides superior symptom relief for up to 12 months. Purpose: To provide an updated summary of the current hip intra-articular injection literature and compare the efficacy of all injection types at 3 months, 6 months, and 12 months. Study Design: Systematic review; Level of evidence, 1. Methods: Four databases were queried: Web of Science, Embase, MEDLINE, and Cochrane Central Register of Controlled Trials. The primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index Total Score (WOMAC–Total) and the visual analog scale (VAS) at 3, 6, and 12 months. The Cochrane risk-of-bias tool was used to assess study quality. Treatment effects were expressed as mean differences for the WOMAC–Total and standardized mean differences for the VAS. Results: A total of 14 studies were included in the final analysis with 1254 participants. Eight unique intra-articular injection types were identified: CS, HA of varying molecular weights (low, high, and ultra-high), PRP, CS + high molecular weight HA, PRP + HA, and standard of care/placebo (SOC/PBO) group. When compared with SOC/PBO, no statistically significant differences in WOMAC–Total and VAS outcomes were observed between any injections at 3, 6, or 12 months. Conclusion: There were no statistically significant differences in WOMAC–Total and VAS outcomes at any time point between all injection types to baseline. Future studies should compare the long-term efficacy of various intra-articular injections with a control and examine the efficacy of combined injections. Registration: CRD42024574937 (PROSPERO identifier).