Predicting outcomes in patients undergoing intra-articular corticosteroid hip injections
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SCIENTIFIC ARTICLE
Predicting outcomes in patients undergoing intra-articular corticosteroid hip injections Thanat Kanthawang 1,2 Rina Patel 1
&
Austin Lee 1 & Joe Darryl Baal 1 & Gabby B. Joseph 1 & Thomas Vail 3 & Thomas M. Link 1 &
Received: 14 July 2020 / Revised: 16 October 2020 / Accepted: 15 November 2020 # ISS 2020
Abstract Objective To investigate the associations between clinical, procedural, and radiographic factors and outcomes of steroid hip injections, including long-term and immediate pain reduction, time to arthroplasty, time to reinjection, and the total number of injections. Materials and methods All intra-articular anesthetic and steroid injections of the hip under fluoroscopic guidance between January 2014 and March 2016 were retrospectively reviewed. Hip radiographs were scored using the Kellgren–Lawrence (KL) and Osteoarthritis Research Society International (OARSI) scores. Immediate pain relief and response were evaluated using a change in visual analog scale and OMERACT-OARSI criteria respectively. Long-term pain relief was evaluated at 2‑7 months after injection by reviewing the medical records. Correlation between patient characteristics, procedural variations, and radiographic factors with injection outcomes was analyzed by using linear and logistic regression models. Results Of 361 injections, 79.8% showed an immediate pain response and 32.7% had subjective long-term pain relief (> 2 months). There was no significant correlation between immediate pain relief and response with long-term pain relief and other outcomes. Older age and higher KL score, OARSI-central joint space narrowing (JSN), and inferior acetabular osteophyte were correlated with long-term pain relief (p = 0.01‑0.03). Higher KL and OARSI grades, particularly JSN, were significantly correlated with increased immediate pain relief and total number of injections but decreased time to arthroplasty. Baseline pain positively correlated with immediate pain response (p < 0.001). Conclusions Older patients with higher grades of radiographic OA and high baseline pain were good candidates for steroid injections, particularly for those patients awaiting hip arthroplasty. Keywords Hip osteoarthritis . Steroid injection . Fluoroscopy . Predictors of response
Introduction Hip osteoarthritis (OA) affects older adults and substantially impacts their mobility and quality of life. The prevalence of
OA between 1999 and 2014 was estimated to be 9.7% of the US population with a projected increase from 37.9 million in 1990 to 59.4 million in 2020 [1]. One in four who live until 85 years will develop symptomatic hip OA [2]. To date, OA
* Thanat Kanthawang [email protected]
Thomas M. Link [email protected] Rina Patel [email protected]
Austin Lee [email protected] Joe Darryl Baal [email protected]
1
Department of Radiology and Biomedical Imaging, University of California, 500 Parnassus Avenue, San Francisco, CA 94143, USA
Gabby B. Joseph [email protected]
2
Department of Radiology, Faculty of Medicine, Chia
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