THE ROLE OF INTRA-ARTICULAR HIP INJECTIONS IN OSTEOARTHRITIS OF THE HIP

Abstract

Introduction: Intra-articular injection (IAJ) with cortico-steroid and local anaesthetic has been used as both diagnostic and therapeutic intervention in osteoarthritis of the hip. Doubt remains about its efficacy in confirming the source of symptoms in patients with both hip and spinal arthritis. There are also concerns about the introduction of infection for patients undergoing surgery.

Methods: All patients undergoing Hip IAJ for osteoarthritis within a 6-month period in 2007 were reviewed for three surgeons at one institution retrospectively. Data was collated and analysed using a set protocol allowing 18 months follow-up period.

Results: 41 procedures (38 patients) had injections within the study period. Male: Female ratio was 17:24. Average age was 52 years. There were 54% right-sided procedures.

25/41 patients had full response to the injection. 80% were listed for surgery as a result (documented reasons in those not listed). 6/41 patients had a partial response to the injection – 66% were managed conservatively (due to co-morbidities elicited at review, or spinal pathology). 10/41 patients had no benefit – 3 were offered surgery (one after MRI confirmation, one after prolonged physiotherapy and one after discussion about diagnostic overlap).

Hip replacement completely reduced symptoms in 19/21 (90%) and partially in 2/21 (10%) (1 had undergone a successful pre-operative IAJ).

There were no deep infections in patients undergoing surgery after injection. 1 patient had a superficial infection (resolved at review).

Discussion: Diagnostic IAJ can be of value in patients when there are concerns whether the origin of symptoms is truly ascribable to the hip. Patients where injections are successful go on to undergo successful surgery without an increased risk of infection.