In Patients With Painful Hip Osteoarthritis, Is It More Beneficial to Offer Them an Ultrasound-Guided or a Fluoroscopic-Guided Intra-Articular Corticosteroid Injection to Relieve Their Symptoms? A Systematic Review and Network Meta-Analysis.

Purpose: Hip osteoarthritis (OA) is a common disabling musculoskeletal condition. Clinical guidelines recommend intra-articular corticosteroid injections (IACSI) as a pharmacological adjunct to help manage pain. IACSI are typically image-guided either by ultrasound guidance (USG) or fluoroscopic guidance (FG) with no clear evidence towards the more efficacious guidance technique. This study aims to systematically review the scientific literature to determine the clinical effectiveness of USG compared with FG-IACSIs for people with pain-related hip OA.

Methods: A systematic review of major bibliographic databases from inception to 24 August 2023 was conducted. Randomised controlled trials of USG- and FG-IACSIs for patients with hip OA were included. The primary outcome measure was pain. Hedges' g calculated effect size and meta-analysis using the random-effects model-estimated pooled effect sizes. τ², I² and Cochran's Q calculated heterogeneity. Network meta-analysis was completed to indirectly compare effect sizes. Quality was assessed using the Cochrane risk-of-bias tool (RoB2).

Results: A total of 1464 citations were identified; eight studies were included in the review. No studies directly compared imaging modalities. Two network meta-analyses indirectly comparing USG- to FG-IACSI via an image-guided comparator hip injection ([any comparator], [local anaesthetic or saline]) established effect sizes (g) of 2.61 and 2.46, respectively, both in favour of FG-IACSI. Heterogeneity was low in the USG studies and high in the FG studies.

Conclusion(s): Evidence suggests that both USG and FG-IACSI are effective at reducing pain at 1 month in patients with painful hip OA. Although network meta-analyses favoured FG-IACSI, further high-quality trials are needed to determine the preferred guidance technique.