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

Skeletal Radiol. 2019 Sep;48(9):1417-1426. doi: 10.1007/s00256-019-03189-x. Epub 2019 Mar 6.

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.

Keywords: Anesthetic; Injection; Osteoarthritis; Steroid.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthetics, Local / therapeutic use*
  • Comorbidity
  • Disease Progression
  • Female
  • Femur Head / diagnostic imaging
  • Femur Head Necrosis / diagnostic imaging
  • Femur Head Necrosis / epidemiology*
  • Follow-Up Studies
  • Glucocorticoids / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / diagnostic imaging
  • Osteoarthritis, Hip / epidemiology*
  • Pain / drug therapy*
  • Pain / epidemiology*
  • Radiography
  • Retrospective Studies
  • Ropivacaine / therapeutic use
  • Triamcinolone / therapeutic use
  • Young Adult

Substances

  • Anesthetics, Local
  • Glucocorticoids
  • Triamcinolone
  • Ropivacaine