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Intra-articular saline injection as effective as corticosteroids, platelet-rich plasma and hyaluronic acid for hip osteoarthritis pain: a systematic review and network meta-analysis of randomised controlled trials
  1. Aaron Gazendam1,
  2. Seper Ekhtiari1,
  3. Anthony Bozzo1,
  4. Mark Phillips2,
  5. Mohit Bhandari1
  1. 1Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
  2. 2Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Aaron Gazendam, Orthopedic Surgery, McMaster University, Hamilton, ON L8S 4L8, Canada; aaron.gazendam{at}


Objective Intra-articular (IA) injections represent a commonly used modality in the treatment of hip osteoarthritis (OA). Commonly used injections include corticosteroids (CCS), hyaluronic acid (HA) and platelet-rich plasma (PRP). A network meta-analysis allows for comparison among more than two treatment arms and uses both direct and indirect comparisons between interventions. The objective of this network meta-analysis is to compare the efficacy of the various IA injectable treatments in treating hip OA at up to 6 months of follow-up.

Design This is a systematic review and network meta-analysis. Bayesian random-effects model was performed to assess the direct and indirect comparisons of all treatment options.

Data sources PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus and Web of Science, from inception to October 2019.

Eligibility criteria for selected studies Randomised controlled trials assessing the efficacy of CCS, HA, PRP and placebo in the form of IA saline injection for patients with hip OA.

Results Eleven randomised controlled trials comprising 1353 patients were included. For pain outcomes at both 2–4 and 6 months, no intervention significantly outperformed placebo IA injection. For functional outcomes at both 2–4 and 6 months, no intervention significantly outperformed placebo IA injection. Regarding change from baseline at 2–4 months and 6 months, pooled data demonstrated that all interventions (including placebo), with the exception of HA+PRP, led to a clinically important improvement in both pain, exceeding the minimal clinically important difference.

Conclusion Evidence suggests that IA hip saline injections performed as well as all other injectable options in the management of hip pain and functional outcomes.

  • osteoarthritis
  • meta-analysis
  • hip
  • randomised controlled trial

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  • Contributors All authors have made substantial contributions to all of the following: conception and design of the study, or acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and final approval of the version to be submitted. All authors have approved the submission of this manuscript. The manuscript, including related data, figures and tables, has not been previously published and is not under consideration elsewhere.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MB reports personal fees from AgNovos Healthcare, personal fees and other from Sanofi Aventis, personal fees and other from Smith & Nephew, personal fees from Stryker, grants from DJ Orthopedics, and other from Ferring Pharmaceuticals, outside the submitted work. No other authors report competing interests.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.