Risks of Intra-articular Hip Corticosteroid Injections Include Rapidly Progressive Osteoarthritis and Femoral Head Collapse in Patients With and Without Pre-existing Osteoarthritis: A Systematic Review

Abstract

Purpose

To identify studies reporting cartilage-related complications associated with hip intra-articular corticosteroid injections (IACSIs).

Methods

A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines by searching PubMed, the Cochrane Library, and Embase to identify any study or case report reporting on cartilage-related complications after IACSIs. The search terms used were as follows: hip AND injection AND corticosteroid. Inclusion criteria included any study or case report reporting on cartilage-related complications after IACSIs. Studies were excluded if they were unrelated to the hip joint, performed injection into the soft tissue surrounding the hip joint, and/or did not report on any complications after corticosteroid injection into the hip joint. The outcomes assessed were rapidly progressive osteoarthritis (RPOA), osteonecrosis (ON), femoral head collapse (FHC), insufficiency fracture (IF), and worsening osteoarthritis (WOA) in patients with and without pre-existing osteoarthritis (OA).

Results

Twenty studies (1 Level II, 12 Level III, 3 Level IV, 4 Level V) met the inclusion criteria, with a total of 34,367 hips that underwent IACSIs. The mean patient age ranged from 50.0 to 78.0 years, the average body mass index ranged from 26.3 to 31.4, and the overall percentage of female patients ranged from 5.5% to 100%. Excluding case reports, the RPOA incidence ranged from 0.2% to 21.1%; ON incidence, from 0.6% to 27.1%; FHC incidence, from 3.2% to 20.4%; IF incidence, from 0.4% to 1.3%; and WOA incidence, from 1.1% to 44.3%.

Conclusions

Risks of IACSI include RPOA, ON, FHC, IF, and WOA, although the incidence rates of these outcomes vary notably. Adverse outcomes occur in patients without pre-existing OA, but most of the available literature reports these outcomes in patients with pre-existing OA.

Level of Evidence

Level V, systematic review of Level II to V studies.