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A Contemporary Analysis of Corticosteroid Injections in Patients with Mild, Moderate, and Severe Hip Osteoarthritis:
Alan D Lam1, Nihir Parikh1, Priya Sivalingam2
1Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Insights
Intraarticular corticosteroid injections (IACSI) for hip osteoarthritis (HOA) show concerning progression in over half of non-severe cases. Most patients proceeded to total hip arthroplasty (THA) with no PRO improvement, questioning IACSI
Area of Science:
- Orthopedics
- Rheumatology
- Radiology
Background:
- Hip osteoarthritis (HOA) is a major cause of disability.
- Intraarticular corticosteroid injections (IACSI) are common for symptomatic HOA.
- The risk of rapidly progressive osteoarthritis (RPOA) after IACSI is understudied.
Purpose of the Study:
- To assess HOA progression rates following IACSI.
- To evaluate progression in mild, moderate, and severe HOA.
- To analyze time to total hip arthroplasty (THA) post-IACSI.
Main Methods:
- Retrospective review of 560 patients undergoing image-guided IACSI for HOA.
- Kellgren-Lawrence (KL) grading (0-4) of pre- and post-injection radiographs.
- Minimum two-year follow-up assessing KL grade changes and time to THA.
Main Results:
- HOA progression of one KL grade occurred in 45.7% of patients with mild/moderate HOA (KL 2-3).
- 21.8% of patients with mild HOA (KL 2) progressed by two KL grades.
- 87.6% of patients underwent THA, with an average time of 206 days; no significant PRO changes.
Conclusions:
- IACSI is associated with significant radiographic HOA progression in over half of patients without severe HOA.
- Minimal improvement in patient-reported outcomes (PROs) and high rates of subsequent THA suggest reconsidering IACSI's utility.
- The safety and efficacy of IACSI for HOA warrant further investigation, particularly regarding RPOA risk.
Background:
Hip osteoarthritis (HOA) represents a leading cause of disability in the United States. Consequently, intraarticular corticosteroid injections (lACSIs) are routinely recommended and utilized for non-surgical management of symptomatic HOA. While they are shown to decrease pain intensity, few studies have reported on the potential risk of rapidly progressive osteoarthritis (RPOA). This study aimed to assess the rate of HOA progression following IACSI in patients with mild, moderate, and severe HOA.
Methods:
This single-institution study retrospectively reviewed patients who underwent image-guided IACSI for HOA between January 1, 2022 and January 1, 2023, with a minimum follow-up of two years. Pre-injection and post-injection radiographs were reviewed to assign HOA grades (0-4) using the Kellgren-Lawrence (KL) classification system. Patients with mild, moderate, and severe (KL 2-4) HOA on pre-injection radiographs were included. Primary outcomes included changes in post-injection KL grades and time-to-total hip arthroplasty (THA).
Results:
There were 560 patients included, with an average age of 66.7 years, a mean BMI of 30.1, and 59.5% women. For patients with pre-injection KL grade < 4 (i.e., mild and moderate HOA or KL grades 2 and 3), there was HOA progression of one level in 185 (45.7%) patients. In the 147 (26.3%) patients with a pre-injection KL grade < 3 (i.e., mild HOA or KL grade 2), 32 (21.8%) increased by two levels. From the total cohort, 491 (87.6%) patients ultimately underwent THA. The average time-to-THA was 206 ± 95.6 days. There were no significant differences between pre-injection and post-injection patient-reported outcomes (PROs).
Conclusion:
Radiographic comparisons before and after IACSI revealed concerning HOA progression in over half the patients without severe HOA. Combined with a minimal change in PROs and most patients electing to undergo THA within the following months, the safety and utility of IACSI in this population must be reconsidered.
Level Of Evidence:
III.
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