髋关节关节内皮质类固醇注射的风险包括有或无骨关节炎患者的快速进行性骨关节炎和股骨头塌陷：一项系统综述

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-08-01 DOI:10.1016/j.asmr.2025.101169

Dylan Parry B.S. , Jaydeep Dhillon D.O. , Matthew J. Kraeutler M.D.

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引用次数: 0

摘要

目的探讨髋关节关节内皮质类固醇注射（IACSIs）相关软骨并发症的相关研究。方法根据系统评价和荟萃分析的首选报告项目指南，检索PubMed、Cochrane图书馆和Embase，对iacsi术后软骨相关并发症的研究或病例报告进行系统评价。使用的搜索词如下：髋关节注射和皮质类固醇。纳入标准包括任何关于IACSIs术后软骨相关并发症的研究或病例报告。如果研究与髋关节无关，在髋关节周围软组织进行注射，和/或没有报告在髋关节注射皮质类固醇后的任何并发症，则排除研究。评估的结果是有或不存在骨关节炎（OA）的患者的快速进行性骨关节炎（RPOA）、骨坏死（ON）、股骨头塌陷（FHC）、不完全性骨折（IF）和恶化的骨关节炎（WOA）。结果20项研究（1项II级研究，12项III级研究，3项IV级研究，4项V级研究）符合纳入标准，共34,367髋行IACSIs。患者平均年龄为50.0 ~ 78.0岁，平均体重指数为26.3 ~ 31.4，女性患者总体比例为5.5% ~ 100%。排除病例报告，RPOA发病率从0.2%到21.1%不等；ON发病率从0.6%降至27.1%；FHC发病率从3.2%降至20.4%；IF发病率从0.4%降至1.3%；WOA发生率从1.1%上升到44.3%。结论IACSI的风险包括RPOA、ON、FHC、IF和WOA，但这些风险的发生率差异较大。不良结果发生在没有既往性骨关节炎的患者中，但大多数现有文献报道这些结果发生在既往性骨关节炎患者中。证据等级：V级，对II至V级研究的系统评价。

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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

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.