Introduction and Aims: Intra-articular steroid hip injection (IASHI) has been extensively administered for painful hip arthritis since the 1950s, but with advances in medical and surgical management, its role is less certain today. There is very little published data on the utility or prescribing patterns of IASHI.

Method: A questionnaire seeking expert opinions on IASHI was developed and distributed to practising Ontario-based members of the Canadian Orthopaedic Association. Initial phone calls identified those who perform hip replacements, and subsequent faxed forms had a 73% response rate (99 surgeons). We systematically describe the current practices and expert opinions of 99 hip surgeons, on the use of IASHI, focusing on indications, current usage, and complications.

Results: Only 56% of surgeons felt that IASHI was actually useful therapeutically, though four in five surgeons cited the usefulness of hip injection for differentiating hip-spine co-morbidity in diagnostically challenging patients. Therapeutic benefit from IASHI was perceived to be poor, with 72% of surgeons estimating that between zero and 60% of their patients achieved any benefit at all from the injections, with duration of benefit uniformly estimated as being between zero and six months. Infection rates were considered to be less than 2% by most surgeons. One quarter of the surgeons felt that IASHI accelerates arthritis progression, most of whom had stated that it would be no great loss if IASHI was no longer available. Nineteen percent of the surgeons believed that there may be increased infection rate of THA after IASHI, and this was associated with lower numbers of IASHI ordered per year, compared to those who did not feel that infection rates would increase. The opinions of this large group of experts is consistent with efficacy studies, and forms a context for our ongoing studies of infected hip arthroplasty post-IASHI.

Conclusion: Opinions were mixed, with substantial numbers of surgeons stating that the procedure is not therapeutically helpful, may accelerate arthritis progression, or may increase infections after subsequent total hip arthroplasty. This information provides a systematic collection of expert opinions, as well as a context for forthcoming studies on effectiveness and complications.

Introduction and Aims: Although cortical hypertrophy (CH) in total hip arthroplasty (THA) has been associated with thigh pain and loose femoral stems, its presence has been variable in the literature, and it is an implant-specific phenomenon. The relationship of bony change to clinical outcome has not previously been examined in ceramic THA.

Method: Hardened-bearing surfaces such as ceramics have the potential for altered patterns of force transmission into the femoral stem-bone interface, and as such could lead to altered bone remodelling. We investigate here the incidence and magnitude of CH at the Gruen zones, about the femoral stem of THA utilising ceramic-on-ceramic bearing surfaces without (n=36) or with (n=4) cement, and metal-polyethylene bearing surfaces without (n=40) or with (n=40) cement. Using multifactorial analysis, we examined the relationship of implant alignment, Harris and Oxford hip scores, and bone remodelling parameters.

Results: In this study of 120 patients, the hip scores and x-rays are examined in the first year after total hip arthroplasty (THA), in order to evaluate bone remodelling in relation to clinical outcomes. Ceramics had the highest incidence (25%) and mean size (1.5 mm) of CH, followed by metal-polyethylene (17%, < 1 mm). No cemented implants exhibited CH. There was no significant relationship of bone remodelling to one-year hip scores, although there were significantly reduced pain scores in cases that exhibited endosteal remodelling at one year. CH in ceramic hips appears to be a mechanical phenomenon that is not associated with pain, varus drift, subsidence, or altered clinical outcome. Cement may buffer the stresses seen by the femur, and hence the stimulus for CH appears to be simply mechanical, and is increased with hardened-bearing surfaces.

Conclusion: CH was more common in ceramic THA than metal-polyethylene, but was not associated with increased thigh pain or altered function. CH did not occur when cement was used, and as such we argue for a mechanical origin of the phenomenon, via altered load transmission into the femur through hardened-bearing surfaces.