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Limited Satisfaction and Increased Risk With Intra-articular Corticosteroid Injections in Patients Who Have Hip
Allan K Metz1, Joshua P Rainey1, Brenna E Blackburn1
1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah.
Insights
Corticosteroid injections (CSI) for hip osteoarthritis offer limited pain relief and satisfaction. Patients receiving CSI before total hip arthroplasty (THA) face a higher risk of septic revision, questioning the overall value of CSI.
Area of Science:
- Orthopedics
- Rheumatology
- Pain Management
Background:
- Intra-articular corticosteroid injections (CSI) are used for hip osteoarthritis but their efficacy and safety are debated.
- Concerns exist regarding patient satisfaction and potential complications following CSI.
Purpose of the Study:
- To assess patient satisfaction with CSI for hip osteoarthritis.
- To evaluate the association between CSI and complications after total hip arthroplasty (THA).
Main Methods:
- A survey assessed pain reduction, relief duration, and satisfaction in 104 patients who received CSI before THA.
- A retrospective review of 1,090 THA patients examined CSI's link to post-operative complications.
Main Results:
- Patients reported an average pain reduction of 5.2 points, with relief lasting 6.2 weeks.
- 44.4% would not undergo CSI again, and 16.5% reported no satisfaction.
- CSI before THA was linked to a significantly increased rate of septic revision (2.0% vs. 0.5%, OR=4.98, P=0.014).
Conclusions:
- CSI provides short-term pain relief for hip osteoarthritis, with nearly half of patients unwilling to repeat the procedure.
- The increased risk of septic revision following CSI before THA raises concerns about its clinical utility.
Background:
The value of intra-articular corticosteroid injections (CSI) in the treatment of hip osteoarthritis has come into question due to concerns regarding efficacy and complication profile. This study aimed to assess patient satisfaction after CSI for hip osteoarthritis and the association of CSI with potential complications following subsequent total hip arthroplasty (THA).
Methods:
A survey was sent to 510 patients who received at least one CSI before THA. Data collected included reduction in visual analog scale pain scores, duration of relief, and patient satisfaction. A retrospective review of 1,090 THA patients at our institution was performed to evaluate the association of CSI to potential complications following THA. Chi-square, Fisher exact, and logistic regression were used for comparison between groups. A total of 104 patients, who had injections in 129 hips, responded (response rate 20.4%); there was 45.8% of patients who had one injection per hip, with a mean of 2.2 injections per hip (range, one to 10).
Results:
Patients reported a mean reduction in visual analog scale pain scores of 5.2 (SD = 3.2), with the average relief lasting 6.2 weeks (SD = 8.4). Of note, 16.5% reported no satisfaction after CSI, and 44.4% stated they would not undergo CSI again. Of the 1,090 THA patients that were retrospectively reviewed, 247 patients (22.7%) received a CSI before THA; this was associated with an increased rate of septic revision (2.0 versus 0.5%, odds ratio = 4.98, P = 0.014). There were no significant differences in aseptic revision rates (P = 0.28).
Conclusions:
Almost half of the patients who received a CSI before THA would not do so again, with average pain relief lasting approximately 6 weeks. Given the increased risk of septic revision for those who underwent CSI before THA, this draws further concern regarding the value of CSI before THA.
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