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Are patients more likely to have hip osteoarthritis progression and femoral head collapse after hip steroid/anesthetic injections? A retrospective observational study

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Abstract

Objective

To evaluate progression of osteoarthritis and femoral head articular surface collapse in hip steroid/anesthetic injection patients (HIPs).

Materials and methods

This study was IRB-approved and HIPAA-compliant. Two musculoskeletal radiologists performed retrospective, blinded reviews of radiography for 70 HIPs (40 mg triamcinolone/4 mL 0.5% preservative-free ropivacaine) with a 3- to 10-month follow-up and two control groups: demographic-matched patients with similar hip radiograph follow-up duration but no injection; and glenohumeral joint injection patients. Discordant evaluations were adjudicated by a third, senior reader. Groups were compared using Fisher’s exact and unpaired t tests.

Results

There were 70 HIPs (mean age 67 ± 17 (range 19–92) years; 44 women, 26 men), who were followed for a mean of 6 ± 2 (3–12) months. Thirty-one (31 out of 70, 44%) of HIPs had progression of osteoarthritis after injection, versus 17 out of 70 (24%) of hip controls (HCs) and 13 out of 44 (30%) of glenohumeral injection patients (GIPs). This difference between HIPs and HCs was statistically significant (p = 0.02) but not that between HIPs and GIPs (0.17). Twelve (12 out of 70, 17%) HIPs had new collapse, compared with 1 out of 70 (1%) of HCs and 1 out of 44 (2%) of GIPs. This difference was statistically significant (HCs: p = 0.002; GIPs: p = 0.02).

Conclusion

Hip steroid/anesthetic injection patients are more likely to demonstrate osteoarthritis progression and femoral head collapse than HC and GIPs in the injected joint 3–12 months after steroid and anesthetic injection. Further evaluation of hip injectates and the injection population is warranted.

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Authors and Affiliations

  1. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA

    F. Joseph Simeone, Joao R. T. Vicentini, Miriam A. Bredella & Connie Y. Chang

Authors
  1. F. Joseph Simeone
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  2. Joao R. T. Vicentini
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  3. Miriam A. Bredella
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  4. Connie Y. Chang
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Correspondence to Connie Y. Chang.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived for individual participants included in the study. The study was approved by the local Institutional Review Board (IRB) and HIPAA-compliant.

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Appendix

Appendix

Table 4 Pre-injection severity of osteoarthritis, pre-injection osteonecrosis, and pre-injection collapse separated by reader 1 and reader 2
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Table 5 Hip injection patients versus hip control (no injection) and shoulder injection groups, separated by reader 1 and reader 2
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Simeone, F.J., Vicentini, J.R.T., Bredella, M.A. et al. Are patients more likely to have hip osteoarthritis progression and femoral head collapse after hip steroid/anesthetic injections? A retrospective observational study. Skeletal Radiol 48, 1417–1426 (2019). https://doi.org/10.1007/s00256-019-03189-x

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