Abstract
Objective
To investigate the associations between clinical, procedural, and radiographic factors and outcomes of steroid hip injections, including long-term and immediate pain reduction, time to arthroplasty, time to reinjection, and the total number of injections.
Materials and methods
All intra-articular anesthetic and steroid injections of the hip under fluoroscopic guidance between January 2014 and March 2016 were retrospectively reviewed. Hip radiographs were scored using the Kellgren–Lawrence (KL) and Osteoarthritis Research Society International (OARSI) scores. Immediate pain relief and response were evaluated using a change in visual analog scale and OMERACT-OARSI criteria respectively. Long-term pain relief was evaluated at 2‑7 months after injection by reviewing the medical records. Correlation between patient characteristics, procedural variations, and radiographic factors with injection outcomes was analyzed by using linear and logistic regression models.
Results
Of 361 injections, 79.8% showed an immediate pain response and 32.7% had subjective long-term pain relief (> 2 months). There was no significant correlation between immediate pain relief and response with long-term pain relief and other outcomes. Older age and higher KL score, OARSI-central joint space narrowing (JSN), and inferior acetabular osteophyte were correlated with long-term pain relief (p = 0.01‑0.03). Higher KL and OARSI grades, particularly JSN, were significantly correlated with increased immediate pain relief and total number of injections but decreased time to arthroplasty. Baseline pain positively correlated with immediate pain response (p < 0.001).
Conclusions
Older patients with higher grades of radiographic OA and high baseline pain were good candidates for steroid injections, particularly for those patients awaiting hip arthroplasty.
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References
Park J, Mendy A, Vieira ER. Various types of arthritis in the United States: prevalence and age-related trends from 1999 to 2014. Am J Public Health. 2018;108(2):256–8.
Murphy LB, Helmick CG, Schwartz TA, Renner JB, Tudor G, Koch GG, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthr Cartil. 2010;18(11):1372–9.
Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil. 2008;16(2):137–62.
Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheum. 2020;72(2):220–33.
Chandrasekaran S, Lodhia P, Suarez-Ahedo C, Vemula SP, Martin TJ, Domb BG. Symposium: evidence for the use of intra-articular cortisone or hyaluronic acid injection in the hip. J Hip Preserv Surg. 2016;3(1):5–15.
McCabe PS, Maricar N, Parkes MJ, Felson DT, O’Neill TW. The efficacy of intra-articular steroids in hip osteoarthritis: a systematic review. Osteoarthr Cartil. 2016;24(9):1509–17.
Zhong HM, Zhao GF, Lin T, Zhang XX, Li XY, Lin JF, et al. Intra-articular steroid injection for patients with hip osteoarthritis: a systematic review and meta-analysis. Biomed Res Int. 2020;2020:6320154.
Walter WR, Bearison C, Slover JD, Gold HT, Gyftopoulos S. Clinical and patient-reported outcomes after image-guided intra-articular therapeutic hip injections for osteoarthritis-related hip pain: a retrospective study. Skelet Radiol. 2019;48(5):713–9.
Flanagan J, Casale FF, Thomas TL, Desai KB. Intra-articular injection for pain relief in patients awaiting hip replacement. Ann R Coll Surg Engl. 1988;70(3):156–7.
Hirsch G, Kitas G, Klocke R. Intra-articular corticosteroid injection in osteoarthritis of the knee and hip: factors predicting pain relief-a systematic review. Semin Arthritis Rheum. 2013;42(5):451–73.
Lai WC, Arshi A, Wang D, Seeger LL, Motamedi K, Levine BD, et al. Efficacy of intraarticular corticosteroid hip injections for osteoarthritis and subsequent surgery. Skelet Radiol. 2018;47(12):1635–40.
Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology. 2019;293(3):656–63.
Xing D, Yang Y, Ma X, Ma J, Ma B, Chen Y. Dose intraarticular steroid injection increase the rate of infection in subsequent arthroplasty: grading the evidence through a meta-analysis. J Orthop Surg Res. 2014;9:107.
Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494–502.
Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthr Cartil. 2007;15(Suppl A):A1–56.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63(Suppl 11):S240–52.
Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M, et al. OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthr Cartil. 2004;12(5):389–99.
Thiese MS, Ronna B, Ott U. P value interpretations and considerations. J Thorac Dis. 2016;8(9):E928–31.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.
EuroQol G. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.
Zhou Y, Yang TB, Wei J, Zeng C, Li H, Yang T, et al. Single-dose intra-articular ropivacaine after arthroscopic knee surgery decreases post-operative pain without increasing side effects: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1651–9.
Dorleijn DM, Luijsterburg PA, Bierma-Zeinstra SM, Bos PK. Is anesthetic hip joint injection useful in diagnosing hip osteoarthritis? A meta-analysis of case series. J Arthroplast. 2014;29(6):1236–42 e1231.
Deshmukh AJ, Thakur RR, Goyal A, Klein DA, Ranawat AS, Rodriguez JA. Accuracy of diagnostic injection in differentiating source of atypical hip pain. J Arthroplast. 2010;25(6 Suppl):129–33.
Deshmukh AJ, Panagopoulos G, Alizadeh A, Rodriguez JA, Klein DA. Intra-articular hip injection: does pain relief correlate with radiographic severity of osteoarthritis? Skelet Radiol. 2011;40(11):1449–54.
van Middelkoop M, Arden NK, Atchia I, Birrell F, Chao J, Rezende MU, et al. The OA Trial Bank: meta-analysis of individual patient data from knee and hip osteoarthritis trials show that patients with severe pain exhibit greater benefit from intra-articular glucocorticoids. Osteoarthr Cartil. 2016;24(7):1143–52.
Plant MJ, Borg AA, Dziedzic K, Saklatvala J, Dawes PT. Radiographic patterns and response to corticosteroid hip injection. Ann Rheum Dis. 1997;56(8):476–80.
Atchia I, Kane D, Reed MR, Isaacs JD, Birrell F. Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis. Ann Rheum Dis. 2011;70(1):110–6.
Lambert RG, Hutchings EJ, Grace MG, Jhangri GS, Conner-Spady B, Maksymowych WP. Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2007;56(7):2278–87.
Robinson P, Keenan AM, Conaghan PG. Clinical effectiveness and dose response of image-guided intra-articular corticosteroid injection for hip osteoarthritis. Rheumatology (Oxford). 2007;46(2):285–91.
Qvistgaard E, Christensen R, Torp-Pedersen S, Bliddal H. Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline. Osteoarthr Cartil. 2006;14(2):163–70.
Reijman M, Hazes JM, Pols HA, Bernsen RM, Koes BW, Bierma-Zeinstra SM. Validity and reliability of three definitions of hip osteoarthritis: cross sectional and longitudinal approach. Ann Rheum Dis. 2004;63(11):1427–33.
Gossec L, Jordan JM, Lam MA, Fang F, Renner JB, Davis A, et al. Comparative evaluation of three semi-quantitative radiographic grading techniques for hip osteoarthritis in terms of validity and reproducibility in 1404 radiographs: report of the OARSI-OMERACT Task Force. Osteoarthr Cartil. 2009;17(2):182–7.
Dowsey MM, Nikpour M, Dieppe P, Choong PF. Associations between pre-operative radiographic osteoarthritis severity and pain and function after total hip replacement: radiographic OA severity predicts function after THR. Clin Rheumatol. 2016;35(1):183–9.
Young R, Harding J, Kingsly A, Bradley M. Therapeutic hip injections: is the injection volume important? Clin Radiol. 2012;67(1):55–60.
Gulihar A, Robati S, Twaij H, Salih A, Taylor GJ. Articular cartilage and local anaesthetic: a systematic review of the current literature. J Orthop. 2015;12(Suppl 2):S200–10.
Piper SL, Kim HT. Comparison of ropivacaine and bupivacaine toxicity in human articular chondrocytes. J Bone Joint Surg Am. 2008;90(5):986–91.
van Tunen JAC, Peat G, Bricca A, Larsen LB, Sondergaard J, Thilsing T, et al. Association of osteoarthritis risk factors with knee and hip pain in a population-based sample of 29-59 year olds in Denmark: a cross-sectional analysis. BMC Musculoskelet Disord. 2018;19(1):300.
Raynauld JP, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2003;48(2):370–7.
Simpson D, Curran MP, Oldfield V, Keating GM. Ropivacaine: a review of its use in regional anaesthesia and acute pain management. Drugs. 2005;65(18):2675–717.
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Kanthawang, T., Lee, A., Baal, J.D. et al. Predicting outcomes in patients undergoing intra-articular corticosteroid hip injections. Skeletal Radiol 50, 1347–1357 (2021). https://doi.org/10.1007/s00256-020-03673-9
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DOI: https://doi.org/10.1007/s00256-020-03673-9