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Intraarticular Steroids in Hip Osteoarthritis - Do They Work?

Apr 27, 2022 3:17 pm

The efficacy of ultrasound guided intra-articular hip injection of corticosteroid in adult hip osteoarthritis (HOA) was shown to be effective when added to conventional current treatment. But was this a clinically meaningful outcome?

A UK study enrolled 199 HOA adults with at least moderate pain in a single blind, randomised controlled trial that compared best current treatment (BCT; advice and education)) to BCT plus ultrasound guided injection of 40 mg triamcinolone and lidocaine, or BCT plus ultrasound guided injection of lidocaine alone. The primary outcome was self-reported hip pain (on a 0-10 Numerical Rating Scale) over six months. The mean age of the cohort was 62.8 years; 57% of whom were women.

Improvement in hip pain intensity over six months was best for BCT plus ultrasound-triamcinolone-lidocaine intraarticular (IA)injections compared with BCT: mean difference −1.43 (95% confidence interval −2.15 to −0.72), P<0.001).

Yes there was no difference in hip pain intensity over six months between those who received IA steriod plus lidocaine versus IA lidocaine alone.

Predictors of response include the presence of ultrasound confirmed synovitis or effusion (−1.70 (−3.10 to −0.30)).

While ultrasound guided intra-articular hip injection of triamcinolone is effective when added to conventional therapy, it was not significantly better than lidocaine alone. Moreover, this study and others have not shown that IA injections alter the ultimate need for interventional hip surgery.  At best, this is a temporizing measure. 

The author has no conflicts of interest to disclose related to this subject

Rheumatologists’ Comments

Stephen soloway

| May 02, 2022 5:16 pm

steroid injections work, they work in all joints, hips facets ALL. they work for carpal or cubital tunnel, mortons neuroma and of course trigger finger. as a multipatent holder of needles, fellow of ralph schumacher, not only do hip injections work better then lidocaine its really sad that any practitioner, orthopedics, pain management and other use ultrasound when its never needed. the money wasted on ultrasound in rheumatology orthopedics and pain management is insane- if anyone from novitas can read(this) , stop paying for ultrasound, insist fellows are trained as they were, and add to the reimbursement of a level 5 new patient which is worth about 600.00 for anyone in practice beyond 10 years. most rheum fellows are now not taught, or a re poorly taught injection skills and techniques, i find this very disheartening

Stephen soloway

| May 03, 2022 4:16 pm

if your injections are not getting the desired results I would recommend having me teach you how to do them correctly. Please for the love of God do not be taught by an orthopedic surgeon. As a fellow with a great H Ralph Schumacher we did bedside hip aspirates on a weekly basis and why would we need ultrasound when the landmarks are always the same? My patented needle for carpal tunnel trigger finger in first CMC are flawless and I traveled the country treating the rich and famous the dignitaries and the regular guys-sorry I have got so much to say about this topic but it is very near and dear to my heart

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