How Effective are Hip Steroid Injections?

Done once, hip steroid injections show “continued response in 1/3 of cases. I would never do once a frozen shoulder injection just once so one sees that the “One Shot Wonder”  society is a alive and well. Their volume was way too high to be a hip injection.

Skeletal Radiol. 2018 Aug 28. doi: 10.1007/s00256-018-3052-z. [Epub ahead of
print]
Efficacy of intraarticular corticosteroid hip injections for osteoarthritis and
subsequent surgery.
Lai WC et al.
https://www.ncbi.nlm.nih.gov/pubmed/30155627

  • quote study finding only 1/2 of orthopods think injection is useful
  • one study got a 56% response to methylprednisolone injections at 14 days, whereas another got a 82% responded to steroid injections at 6 – 8 weeks
  • severity was not found to predict results not BMI
  • duration of over 5 years blunts response
  • this study – 82 injections in 78 cases; more females than males; 64.4 average age

Technique (verbatum):

“Under fluoroscopic guidance, an anterior approach was used with the target needle tip at the lateral aspect of the femoral head/neck junction. A 22-G spinal needle was used for all injections with the intraarticular position confirmed by injection of 2 –3 cc of contrast medium Iohexol (Omnipaque™) 180 or Iothalamate meglumine (Conray®) 60. A total of 1 cc of 80 mg of methylprednisolone and 5 to10 cc of 0.5% ropivacaine was then injected into the hip joint”
HuH??? the hip joint will only hold 1cc – what are they doing????
Results:

19.5% showed no relief,
47.6% showed immediate response(≤2 weeks of pain relief)
32.9% showed continued response (>2 weeks of pain relief)
men did better (p <0.05)
about 1/2 had hip resurfacing or replacement within 2 years from injection
Comment –
it is commendable they did study under imaging but unlikely that 6 mls went into hip joint. The slavery to one shot or nothing is very annoying to see.
A recent platelet rich plasma + hyaluronic acid  into knee article found THREE injections got superior results:
Knee Surg Sports Traumatol Arthrosc. 2017 Mar;25(3):958-965. doi:
10.1007/s00167-015-3705-6. Epub 2015 Aug 2.
Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind,placebo-controlled trial.
Görmeli G et al

When will they ever learn.

As for the steroid quantity – I use triamcinolone – I let it settle out and dispose of supernatant. I mix the concentrate with 2-5% lidocaine and keep it to 1 ml.

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