Limited Satisfaction and Increased Risk with Intra-Articular Corticosteroid Injections in Patients Who Have Hip Osteoarthritis Needing Total Hip Arthroplasty.

Abstract

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 at our institution before THA. Data collected included reduction in visual analog scale (VAS) pain scores, duration of relief, patient satisfaction, and if the patient would elect to receive another CSI. 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 were 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 VAS 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%, OR [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 six 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.