Intra-articular corticosteroid hip injections: a review of 63 consecutive patients

Abstract

In our study of 63 consecutive patients, we present the result of prospective intra-articular injections of bupivacaine and methylprednisolone acetate for osteoarthritis of the hip. Fluoroscopically guided intra-articular hip injections were performed in operating theatre. The effectiveness of the injection was assessed by the help of oxford hip score and was measured before the injection and then at 3 months after the injection. At 3 months, fifty-one patients (81%) showed improvement, four patients (6.3%) showed no improvement while eight patients (12.7%) were worse off after the injection. Two patients had thigh numbness after the procedure, which improved later. No statistical differences were found in the pre-injection and post-injection Oxford hip scores. We conclude that intra-articular hip injections of bupivacaine and methylprednisolone is a safe technique, which can be used with care in patients deemed not fit for hip replacement.

Résumé

Nous rapportons les résultats de 63 injections intra-articulaires de bupivacaïne et d’acétate de méthylprednisolone dans des hanches arthrosiques. Les injections ont été réalisées sous fluoroscopie en salle d’opératio. Le résultat de l’injection a été évalué à l’aide du score de hanche d’Oxford, score effectué avant et 3 mois après l’injection. A 3 mois, 51 patients (81%) présentent une amélioration, 4 patients (6,3%) n’ont pas d’amélioration et 8 patients (12,7%) présentent une aggravation. Les différences observées entre les scores pré- et post-injection ne sont pas statistiquement significatives. Deux patients ont présenté des sensations de tiraillement dans la cuisse après l’injection, qui se sont améliorées spontanément. Nous concluons que l’injection intra-articulaire de bupivacaïne et d’acétate de méthylprednisolone est une procédure sans danger qui peut être utilisée chez les patients pour lesquels l’intervention est jugée prématurée.

Oxford hip score

Please answer the following 12 questions. Choose only one answer per question. The value for each answer is indicated to the left of the answer. Total up all of your answers to obtain a total score out of 60 points

During the past 4 weeks...
1.How would you describe the pain you usually have in your hip?
1) None	2) Very mild	3) Mild	4) Moderate	5) Severe
2. Have you been troubled by pain from your hip in bed at night?
1) No nights	2) Only 1 or 2 nights	3) Some nights	4) Most nights	5) Every night
3. Have you had any sudden, severe pain- shooting’, stabbing’, or spasms’ from your affected hip?
1) No days	2) Only 1 or 2 days	3) Some days	4) Most days	5) Every day
4. Have you been limping when walking because of your hip?
1) Rarely/never	2) Sometimes or just at first	3) Often, not just at first	4) Most of the time	5) All of the time
5. For how long have you been able to walk before the pain in your hip becomes severe (with or without a walking aid)?
1) No pain for 30 min or more	2) 16–30 min	3) 5–15 min	4) Around the house only	5) Not at all
6. Have you been able to climb a flight of stairs?
1) Yes, easily	2) With little difficulty	3) With moderate difficulty	4) With extreme difficulty	5) No, impossible

Please answer the following 12 questions. Choose only one answer per question. The value for each answer is indicated to the left of the answer. Total up all of your answers to obtain a total score out of 60 points

During the past 4 weeks...
1. How would you describe the pain you usually have in your hip?
1) None	2) Very mild	3) Mild	4) Moderate	5) Severe
2. Have you been troubled by pain from your hip in bed at night?
1) No nights	2) Only 1 or 2 nights	3) Some nights	4) Most nights	5) Every night
3. Have you had any sudden, severe pain- shooting’, stabbing’, or spasms’ from your affected hip?
1) No days	2) Only 1 or 2 days	3) Some days	4) Most days	5) Every day
4. Have you been limping when walking because of your hip?
1) Rarely/never	2) Sometimes or just at first	3) Often, not just at first	4) Most of the time	5) All of the time
5. For how long have you been able to walk before the pain in your hip becomes severe (with or without a walking aid)?
1) No pain for 30 min or more	2) 16–30 min	3) 5–15 min	4) Around the house only	5) Not at all
6. Have you been able to climb a flight of stairs?
1) Yes, easily	2) With little difficulty	3) With moderate difficulty	4) With extreme difficulty	5) No, impossible
7. Have you been able to put on a pair of socks, stockings or tights?
1) Yes, easily	2) With little difficulty	3) With moderate difficulty	4) With extreme difficulty	5) No, impossible
8. After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your hip?
1) Not at all painful	2) Slightly painful	3) Moderately painful	4) Very painful	5) Unbearable
9. Have you had any trouble getting in and out of a car or using public transportation because of your hip?
1) No trouble at all	2) Very little trouble	3) Moderate trouble	4) Extreme difficulty	5) Impossible to do
10. Have you had any trouble with washing and drying yourself (all over) because of your hip?
1) No trouble at all	2) Very little trouble	3) Moderate trouble	4) Extreme difficulty	5) Impossible to do
11. Could you do the household shopping on your own?
1) Yes, easily	2) With little difficulty	3) With moderate difficulty	4) With extreme difficulty	5) No, impossible
12. How much has pain from your hip interfered with your usual work, including housework?
1) Not at all	2) A little bit	3) Moderately	4) Greatly	5) Totally