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Injections prior to hip arthroscopy are associated with increased risk of repeat hip arthroscopy at 1 and 5 years

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Previous studies have shown that intra-articular hip injections prior to hip arthroscopy (HA) can be a helpful diagnostic tool. However, local anesthetic and corticosteroid injections can be chondrotoxic and corticosteroid injections have been shown to increase the risk of infection during subsequent surgical intervention. The purpose of this study was to evaluate whether preoperative injections adversely affect outcomes of HA using a national database.

Materials and methods

The TriNetX database was retrospectively queried. Patients undergoing HA for femoroacetabular impingement with at least 1 year of claims runout were included in the analysis. Patients were grouped by whether they had a hip injection within 1 year prior to HA. The rates of repeat HA, total hip arthroplasty (THA), infection, osteonecrosis, and new onset hip OA at 1- and 5-years postoperatively were compared between groups. Statistical significance was assessed at α = 0.05.

Results

6511 HA patients with previous injection and 1178 HA patients without previous injection were included. Patients with a previous injection were overall younger (32.3 vs. 34.7 years, p < 0.001), more likely to be female (69 vs. 48%, p < 0.001) and had a higher BMI (26.3 vs. 25.7 kg/m2, p = 0.043). At 1 and 5-years postoperatively, patients with any injection were 1.43 (p < 0.001) and 1.89 (p < 0.001) times more likely to undergo repeat HA, respectively. At 1 and 5-years postoperatively, patients who underwent a corticosteroid injection were 2.29 (p < 0.001) and 1.89 (p < 0.001) times more likely to undergo repeat HA than patients with local anesthetic injection only and 1.56 (p < 0.001) and 2.08 (p < 0.001) times more likely to undergo repeat HA than patients with no injection.

Conclusions

Intraarticular hip injections prior to hip arthroscopy, particularly corticosteroid injections, are associated with increased risk of repeat hip arthroscopy at 1 and 5 years. Additional studies are needed to elucidate this risk.

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References

  1. Kyin C, Maldonado DR, Go CC, Shapira J, Lall AC, Domb BG (2021) Mid- to long-term outcomes of hip arthroscopy: a systematic review. Arthroscopy 37:1011–1025. https://doi.org/10.1016/j.arthro.2020.10.001

    Article  PubMed  Google Scholar 

  2. Imam S, Khanduja V (2011) Current concepts in the diagnosis and management of femoroacetabular impingement. Int Orthop 35:1427–1435. https://doi.org/10.1007/s00264-011-1278-7

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zusmanovich M, Haselman W, Serrano B, Banffy M (2022) The incidence of hip arthroscopy in patients with femoroacetabular impingement syndrome and labral pathology increased by 85% between 2011 and 2018 in the United States. Arthroscopy 38:82–87. https://doi.org/10.1016/j.arthro.2021.04.049

    Article  PubMed  Google Scholar 

  4. Maradit Kremers H, Schilz SR, Van Houten HK, Herrin J, Koenig KM, Bozic KJ, Berry DJ (2017) Trends in utilization and outcomes of hip arthroscopy in the United States between 2005 and 2013. J Arthroplasty 32:750–755. https://doi.org/10.1016/j.arth.2016.09.004

    Article  PubMed  Google Scholar 

  5. Lin LJ, Akpinar B, Bloom DA, Youm T (2021) Age and outcomes in hip arthroscopy for femoroacetabular impingement: a comparison across 3 age groups. Am J Sports Med 49:82–89. https://doi.org/10.1177/0363546520974370

    Article  PubMed  Google Scholar 

  6. Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Jt Surg Br 91:16–23. https://doi.org/10.1302/0301-620X.91B1.21329

    Article  CAS  Google Scholar 

  7. Ayeni OR, Farrokhyar F, Crouch S, Chan K, Sprague S, Bhandari M (2014) Pre-operative intra-articular hip injection as a predictor of short-term outcome following arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 22:801–805. https://doi.org/10.1007/s00167-014-2883-y

    Article  PubMed  Google Scholar 

  8. Li S, Li C, Wang H, Luo Y, Li H, Zhang M (2021) Utility of ultrasound-guided anesthetic intra-articular injection to estimate the outcome of hip arthroscopy in patients with femoroacetabular impingement syndrome. Orthop Surg 13:1810–1817. https://doi.org/10.1111/os.13104

    Article  PubMed  PubMed Central  Google Scholar 

  9. Khan W, Khan M, Alradwan H, Williams R, Simunovic N, Ayeni OR (2015) Utility of intra-articular hip injections for femoroacetabular impingement: a systematic review. Orthop J Sports Med 3:2325967115601030. https://doi.org/10.1177/2325967115601030

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kivlan BR, Martin RL, Sekiya JK (2011) Response to diagnostic injection in patients with femoroacetabular impingement, labral tears, chondral lesions, and extra-articular pathology. Arthroscopy 27:619–627. https://doi.org/10.1016/j.arthro.2010.12.009

    Article  PubMed  Google Scholar 

  11. Mujahed T, Hassebrock JD, Makovicka JL, Pollock JR, Wilcox JG, Patel KA, Economopoulos KJ (2021) Preoperative intra-articular steroid injections as predictors of hip arthroscopy: 2-year outcomes. Orthop J Sports Med 9:23259671211053816. https://doi.org/10.1177/23259671211053817

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rampal S, Jaiman A, Tokgoz MA, Arumugam G, Sivananthan S, Singh RSJ, Zazali SB, Mohaddes M (2022) A review of the efficacy of intraarticular hip injection for patients with hip osteoarthritis: to inject or not to inject in hip osteoarthritis? Jt Dis Relat Surg 33:255–262. https://doi.org/10.52312/jdrs.2022.402

    Article  PubMed  PubMed Central  Google Scholar 

  13. Dragoo JL, Danial CM, Braun HJ, Pouliot MA, Kim HJ (2012) The chondrotoxicity of single-dose corticosteroids. Knee Surg Sports Traumatol Arthrosc 20:1809–1814. https://doi.org/10.1007/s00167-011-1820-6

    Article  PubMed  Google Scholar 

  14. Braun HJ, Wilcox-Fogel N, Kim HJ, Pouliot MA, Harris AH, Dragoo JL (2012) The effect of local anesthetic and corticosteroid combinations on chondrocyte viability. Knee Surg Sports Traumatol Arthrosc 20:1689–1695. https://doi.org/10.1007/s00167-011-1728-1

    Article  PubMed  Google Scholar 

  15. Wang D, Camp CL, Ranawat AS, Coleman SH, Kelly BT, Werner BC (2017) The timing of hip arthroscopy after intra-articular hip injection affects postoperative infection risk. Arthroscopy 33(1988–1994):e1981. https://doi.org/10.1016/j.arthro.2017.06.037

    Article  Google Scholar 

  16. Cancienne JM, Werner BC (2021) The risk of early infection following intra-articular corticosteroid injection following shoulder arthroplasty. Shoulder Elbow 13:605–609. https://doi.org/10.1177/1758573220925817

    Article  PubMed  Google Scholar 

  17. Qin MM, Qin CD, Johnson DJ, Kalainov DM (2021) Risk of infection in thumb carpometacarpal surgery after corticosteroid injection. J Hand Surg Am 46(765–771):e762. https://doi.org/10.1016/j.jhsa.2021.04.010

    Article  Google Scholar 

  18. Belk JW, Keeling LE, Kraeutler MJ, Snow MG, Mei-Dan O, Scillia AJ, McCarty EC (2021) Risk of infection in knee arthroscopy patients undergoing corticosteroid injections in the perioperative period. Orthop J Sports Med 9:23259671211032940. https://doi.org/10.1177/23259671211032941

    Article  PubMed  PubMed Central  Google Scholar 

  19. TriNetX. https://trinetx.com/company-overview/. Accessed 3 May 2022

  20. Nwachukwu BU, Beck EC, Lee EK, Cancienne JM, Waterman BR, Paul K, Nho SJ (2020) Application of machine learning for predicting clinically meaningful outcome after arthroscopic femoroacetabular impingement surgery. Am J Sports Med 48:415–423. https://doi.org/10.1177/0363546519892905

    Article  PubMed  Google Scholar 

  21. Kunze KN, Polce EM, Clapp IM, Alter T, Nho SJ (2022) Association between preoperative patient factors and clinically meaningful outcomes after hip arthroscopy for femoroacetabular impingement syndrome: a machine learning analysis. Am J Sports Med 50:746–756. https://doi.org/10.1177/03635465211067546

    Article  PubMed  Google Scholar 

  22. Stout A, Friedly J, Standaert CJ (2019) Systemic absorption and side effects of locally injected glucocorticoids. PM R 11:409–419. https://doi.org/10.1002/pmrj.12042

    Article  PubMed  Google Scholar 

  23. Cancienne JM, Werner BC, Luetkemeyer LM, Browne JA (2015) Does timing of previous intra-articular steroid injection affect the post-operative rate of infection in total knee arthroplasty? J Arthroplasty 30:1879–1882. https://doi.org/10.1016/j.arth.2015.05.027

    Article  PubMed  Google Scholar 

  24. Schairer WW, Nwachukwu BU, Mayman DJ, Lyman S, Jerabek SA (2016) Preoperative hip injections increase the rate of periprosthetic infection after total hip arthroplasty. J Arthroplasty 31(166–169):e161. https://doi.org/10.1016/j.arth.2016.04.008

    Article  Google Scholar 

  25. Werner BC, Cancienne JM, Browne JA (2016) The timing of total hip arthroplasty after intraarticular hip injection affects postoperative infection risk. J Arthroplasty 31:820–823. https://doi.org/10.1016/j.arth.2015.08.032

    Article  PubMed  Google Scholar 

  26. Byrd JWT, Bardowski EA, Civils AN, Parker SE (2019) The safety of hip arthroscopy within 3 months of an intra-articular injection. J Bone Jt Surg Am 101:1467–1469. https://doi.org/10.2106/JBJS.19.00147

    Article  Google Scholar 

  27. Varady NH, Amen TB, Abraham PF, Chopra A, Freccero DM, Smith EL, Martin SD (2021) Image-guided intra-articular hip injections and risk of infection after hip arthroscopy. Am J Sports Med 49:2482–2488. https://doi.org/10.1177/03635465211022798

    Article  PubMed  Google Scholar 

  28. Freire V, Bureau NJ (2016) Injectable corticosteroids: take precautions and use caution. Semin Musculoskelet Radiol 20:401–408. https://doi.org/10.1055/s-0036-1594286

    Article  PubMed  Google Scholar 

  29. Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A (2019) Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology 293:656–663. https://doi.org/10.1148/radiol.2019190341

    Article  PubMed  Google Scholar 

  30. Hoit G, Whelan DB, Ly P, Saskin R, Atrey A, Khoshbin A (2021) Conversion to total hip arthroplasty after hip arthroscopy: a cohort-based survivorship study with a minimum of 2-year follow-up. J Am Acad Orthop Surg 29:885–893. https://doi.org/10.5435/JAAOS-D-20-00748

    Article  PubMed  Google Scholar 

  31. Scher DL, Belmont PJ Jr, Owens BD (2010) Case report: osteonecrosis of the femoral head after hip arthroscopy. Clin Orthop Relat Res 468:3121–3125. https://doi.org/10.1007/s11999-010-1256-1

    Article  PubMed  PubMed Central  Google Scholar 

  32. Dean BJ, Lostis E, Oakley T, Rombach I, Morrey ME, Carr AJ (2014) The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum 43:570–576. https://doi.org/10.1016/j.semarthrit.2013.08.006

    Article  CAS  PubMed  Google Scholar 

  33. Puzzitiello RN, Patel BH, Forlenza EM, Nwachukwu BU, Allen AA, Forsythe B, Salzler MJ (2020) Adverse impact of corticosteroids on rotator cuff tendon health and repair: a systematic review of basic science studies. Arthrosc Sports Med Rehabil 2:e161–e169. https://doi.org/10.1016/j.asmr.2020.01.002

    Article  PubMed  PubMed Central  Google Scholar 

  34. Pelletier JP, Raynauld JP, Abram F, Dorais M, Paiement P, Martel-Pelletier J (2020) Intra-articular corticosteroid knee injection induces a reduction in meniscal thickness with no treatment effect on cartilage volume: a case-control study. Sci Rep 10:13789. https://doi.org/10.1038/s41598-020-70064-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Degen RM, Pan TJ, Chang B, Mehta N, Chamberlin PD, Ranawat AS, Nawabi DH, Kelly BT, Lyman S (2017) Risk of failure of primary hip arthroscopy-a population-based study. J Hip Preserv Surg 4:214–223. https://doi.org/10.1093/jhps/hnx018

    Article  PubMed  PubMed Central  Google Scholar 

  36. Haefeli PC, Albers CE, Steppacher SD, Tannast M, Buchler L (2017) What are the risk factors for revision surgery after hip arthroscopy for femoroacetabular impingement at 7-year followup? Clin Orthop Relat Res 475:1169–1177. https://doi.org/10.1007/s11999-016-5115-6

    Article  PubMed  Google Scholar 

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Orthopedic Research, Anne Arundel Medical Center, Annapolis, MD, USA

    Andrea H. Johnson & Jane C. Brennan

  2. Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, MD, USA

    Alyssa Maley, Sandra B. Levermore & Benjamin M. Petre

  3. Orthopedic and Surgical Research, Anne Arundel Medical Center, 2000 Medical Parkway Suite 503, Annapolis, MD, 21401, USA

    Justin J. Turcotte

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Benjamin Petre is a paid consultant for Smith and Nephew. The remainder of the authors have no competing interests to declare.

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Johnson, A.H., Brennan, J.C., Maley, A. et al. Injections prior to hip arthroscopy are associated with increased risk of repeat hip arthroscopy at 1 and 5 years. Arch Orthop Trauma Surg 144, 823–829 (2024). https://doi.org/10.1007/s00402-023-05164-7

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