Intra-articular saline injection is 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

Br J Sports Med. 2021 Mar;55(5):256-261. doi: 10.1136/bjsports-2020-102179. Epub 2020 Aug 22.


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.

Keywords: hip; meta-analysis; osteoarthritis; randomised controlled trial.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Arthralgia / drug therapy*
  • Humans
  • Hyaluronic Acid / therapeutic use*
  • Injections, Intra-Articular*
  • Osteoarthritis, Hip / drug therapy*
  • Pain Measurement
  • Platelet-Rich Plasma*
  • Randomized Controlled Trials as Topic
  • Saline Solution / therapeutic use*


  • Adrenal Cortex Hormones
  • Saline Solution
  • Hyaluronic Acid