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Clinical and patient-reported outcomes after image-guided intra-articular therapeutic hip injections for osteoarthritis-related hip pain: a retrospective study

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Abstract

Objective

To evaluate change in patient-reported outcomes following image-guided intra-articular therapeutic steroid hip injections for pain and assess correlations of outcomes with patient- and injection-specific factors.

Materials and methods

We retrospectively reviewed consecutive patients treated for hip pain who completed outcomes assessments from October 2011 to September 2017 at an outpatient orthopedic surgery clinic. Only patients with radiographic hip osteoarthritis (Tönnis grade ≥ 1) who underwent steroid hip injections were included. Outcomes assessments included EuroQol-5 domain (EQ5D), EQ5D-visual analog scale (VAS), and hip disability and osteoarthritis outcome score (HOOS), obtained before and within 1–6 months post-injection. Among 113 patients who completed surveys, the mean age was 59 years (±13.7 years), including 77 women (68%) and 36 men (32%). Time to repeat injection or arthroplasty was recorded. Exact Wilcoxon signed rank test assessed score differences and Spearman correlation, Kruskal–Wallis, and Mann–Whitney tests assessed correlations.

Results

Of 113 patients, 34 had outcomes measured at <8 weeks and 79 at ≥8 weeks. There was no significant change among any of the patients, short- or long-term follow-up subgroups in EQ5D (p = 0.450, 0.770, 0.493 respectively), EQ5D-VAS (p = 0.581, 0.915, 0.455), average-HOOS (p = 0.478, 0.696, 0.443) or total-HOOS (p = 0.380, 0.517, 0.423) scores. Forty-nine patients underwent hip arthroplasty within 1 year. Positive correlation was found between days from injection to surgery and change in EQ5D (r = 0.29, p = 0.025), average-HOOS (r = 0.33, p = 0.019), and total-HOOS (r = 0.37, p = 0.008).

Conclusion

We demonstrated no significant change in patient-reported outcomes measured at short- and long-term intervals up to 6 months after therapeutic steroid hip injections.

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References

  1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2163–96.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Dagenais S, Garbedian S, Wai EK. Systematic review of the prevalence of radiographic primary hip osteoarthritis. Clin Orthop Relat Res. 2009;467(3):623–37.

    Article  PubMed  Google Scholar 

  3. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(7):1323–30.

    Article  PubMed  Google Scholar 

  4. Bierma-Zeinstra SM, Koes BW. Risk factors and prognostic factors of hip and knee osteoarthritis. Nat Clin Pract Rheumatol. 2007;3(2):78–85.

    Article  PubMed  Google Scholar 

  5. Felson DT, Hodgson R. Identifying and treating preclinical and early osteoarthritis. Rheum Dis Clin N Am. 2014;40(4):699–710.

    Article  Google Scholar 

  6. Le TK, Montejano LB, Cao Z, Zhao Y, Ang D. Health care costs in US patients with and without a diagnosis of osteoarthritis. J Pain Res. 2012;5:23–30.

    PubMed  PubMed Central  Google Scholar 

  7. Litwic A, Edwards MH, Dennison EM, Cooper C. Epidemiology and burden of osteoarthritis. Br Med Bull. 2013;105:185–99.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hunter DJ, Schofield D, Callander E. The individual and socioeconomic impact of osteoarthritis. Nat Rev Rheumatol. 2014;10(7):437–41.

    Article  PubMed  Google Scholar 

  9. Zhu X, Sang L, Wu D, Rong J, Jiang L. Effectiveness and safety of glucosamine and chondroitin for the treatment of osteoarthritis: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2018;13(1):170.

    Article  PubMed  PubMed Central  Google Scholar 

  10. American Academy of Orthopaedic Surgeons. Management of osteoarthritis of the hip. Evidence-based clinical practice guidelines. 2017.

  11. Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, et al. American medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. PM R. 2015;7(2):151–68.e12.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. McCabe PS, Maricar N, Parkes MJ, Felson DT, O’Neill TW. The efficacy of intra-articular steroids in hip osteoarthritis: a systematic review. Osteoarthritis Cartilage. 2016;24(9):1509–17.

    Article  CAS  PubMed  Google Scholar 

  14. Subedi N, Chew NS, Chandramohan M, Scally AJ, Groves C. Effectiveness of fluoroscopy-guided intra-articular steroid injection for hip osteoarthritis. Clin Radiol. 2015;70(11):1276–80.

    Article  CAS  PubMed  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

  16. Kruse DW. Intraarticular cortisone injection for osteoarthritis of the hip. Is it effective? Is it safe? Curr Rev Musculoskelet Med. 2008;1(3–4):227–33.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Byrd JW, Potts EA, Allison RK, Jones KS. Ultrasound-guided hip injections: a comparative study with fluoroscopy-guided injections. Arthroscopy. 2014;30(1):42–6.

    Article  PubMed  Google Scholar 

  18. Kullenberg B, Runesson R, Tuvhag R, Olsson C, Resch S. Intraarticular corticosteroid injection: pain relief in osteoarthritis of the hip? J Rheumatol. 2004;31(11):2265–8.

    PubMed  Google Scholar 

  19. Krych AJ, Sousa PL, King AH, Engasser WM, Levy BA. Intra-articular diagnostic injection exhibits poor predictive value for outcome after hip arthroscopy. Arthroscopy. 2016;32(8):1592–600.

    Article  PubMed  Google Scholar 

  20. Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34(5):505–14.

    Article  CAS  PubMed  Google Scholar 

  21. EuroQol G. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.

    Article  Google Scholar 

  22. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Klassbo M, Larsson E, Mannevik E. Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster universities osteoarthritis index. Scand J Rheumatol. 2003;32(1):46–51.

    Article  PubMed  Google Scholar 

  24. Bruckl R, Hepp WR, Tonnis D. Differentiation of normal and dysplastic juvenile hip joints by means of the summarized hip factor. Arch Orthop Unfallchir. 1972;74(1):13–32.

    Article  CAS  PubMed  Google Scholar 

  25. Dall’Oca C, Trivellin G, D’Orazio L, Sambugaro E, Mezzari S, Zanetti G, et al. Hip arthroscopy in osteoarthritis consequent to FAI. Acta Biomed. 2016;87(Suppl 1):46–52.

    PubMed  Google Scholar 

  26. Deshmukh AJ, Panagopoulos G, Alizadeh A, Rodriguez JA, Klein DA. Intra-articular hip injection: does pain relief correlate with radiographic severity of osteoarthritis? Skeletal Radiol. 2011;40(11):1449–54.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. Garg N, Perry L, Deodhar A. Intra-articular and soft tissue injections, a systematic review of relative efficacy of various corticosteroids. Clin Rheumatol. 2014;33(12):1695–706.

    Article  PubMed  Google Scholar 

  30. 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. Osteoarthritis Cartilage. 2006;14(2):163–70.

    Article  CAS  PubMed  Google Scholar 

  31. Philippon MJ, Bolia IK. Intra-articular hip injection is a valuable and cost-effective diagnostic tool but replacing advanced diagnostic methods is not currently the way to go: commentary on an article by Daniel J. Cunningham, MD, MHS, et al.: "Advanced imaging adds little value in the diagnosis of femoroacetabular impingement syndrome". J Bone Joint Surg Am. 2017;99(24):e138.

    Article  PubMed  Google Scholar 

  32. Cunningham DJ, Lewis BD, Hutyra CA, Mather RC, Olson SA. Early recovery after hip arthroscopy for femoroacetabular impingement syndrome: a prospective, observational study. J Hip Preserv Surg. 2017;4(4):299–307.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Kaspar J, Kaspar S, Orme C, de V de Beer J. Intra-articular steroid hip injection for osteoarthritis: a survey of orthopedic surgeons in Ontario. Can J Surg. 2005;48(6):461–9.

    PubMed  PubMed Central  Google Scholar 

  34. Pasquale MK, Louder AM, Cheung RY, Reiners AT, Mardekian J, Sanchez RJ, et al. Healthcare utilization and costs of knee or hip replacements versus pain-relief injections. Am Health Drug Benefits. 2015;8(7):384–94.

    PubMed  PubMed Central  Google Scholar 

  35. Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, et al. Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2003;85-A(1):27–32.

    Article  Google Scholar 

  36. Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162(1):46–54.

    Article  PubMed  Google Scholar 

  37. Pereira LC, Kerr J, Jolles BM. Intra-articular steroid injection for osteoarthritis of the hip prior to total hip arthroplasty : is it safe? A systematic review. Bone Joint J. 2016;98-B(8):1027–35.

    Article  CAS  PubMed  Google Scholar 

  38. Freeman JJ, Kilani RK, Lascola CD, Gray L, Enterline DS. Trends in spinal pain management injections in academic radiology departments. AJNR Am J Neuroradiol. 2013;34(1):247–51.

    Article  CAS  PubMed  Google Scholar 

  39. Balog TP, Rhodehouse BB, Turner EK, Slevin JM, Bush LA, Grassbaugh JA, et al. Accuracy of ultrasound-guided intra-articular hip injections performed in the orthopedic clinic. Orthopedics. 2017;40(2):96–100.

    Article  PubMed  Google Scholar 

  40. Zygmont ME, Itri JN, Rosenkrantz AB, Duong PT, Mankowski Gettle L, Mendiratta-Lala M, et al. Radiology research in quality and safety: current trends and future needs. Acad Radiol. 2017;24(3):263–72.

    Article  PubMed  Google Scholar 

  41. Weldring T, Smith SM. Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs). Health Serv Insights. 2013;6:61–8.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Musculoskeletal Division, NYU Langone Health, 301 E. 17th Street, 6th Floor, New York, NY, 10003, USA

    William R. Walter

  2. Mount Sinai Beth Israel Medical Center, New York, NY, USA

    Craig Bearison

  3. Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA

    James D. Slover

  4. Department of Orthopedic Surgery and Department of Population Health, NYU Langone Health, New York, NY, USA

    Heather T. Gold

  5. Department of Radiology, Musculoskeletal Division, NYU Langone Health, New York, NY, USA

    Soterios Gyftopoulos

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  1. William R. Walter
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Correspondence to William R. Walter.

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Walter, W.R., Bearison, C., Slover, J.D. et al. Clinical and patient-reported outcomes after image-guided intra-articular therapeutic hip injections for osteoarthritis-related hip pain: a retrospective study. Skeletal Radiol 48, 713–719 (2019). https://doi.org/10.1007/s00256-018-3113-3

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  • DOI: https://doi.org/10.1007/s00256-018-3113-3

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