Patients with osteoarthritis who receive hip injections of steroids plus anesthetics may experience higher rates of osteonecrosis and collapse compared with patients receiving shoulder injections and sham hip injections, according a study presented at the Radiological Society of North America’s 2017 annual meeting held November 26 to December 1 in Chicago, Illinois.

Researchers evaluated outcomes in patients with OA injected with 40 mg triamcinolone and 4 mL 0.5% preservative-free ropivicaine in the hip (n=102), or in the glenohumeral joint (n=44), or receiving control hip injections (n=102). Two researchers performed a retrospective, blinded review of radiography findings before and after injection and compared these findings with the 2 matched control groups.

According to the first reviewer, 37% of patients receiving steroid hip injections showed worsening osteoarthritis compared with 32% of patients receiving shoulder injections and 26% of participants not receiving injections. The second reviewer found comparable percentages for all 3 groups, with 41% of patients injected in the hip injection displaying increased osteoarthritis vs 23% of participants receiving shoulder injections, and 20% of participants given sham hip injections.

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In addition, the first reviewer found that 24% of hip injection patients had developed new osteonecrosis during the study period vs 20% observed by the second review. Reviewers 1 and 2 found that 15% and 17% of study participants developed collapse after hip steroid injection vs 5% and 2% of participants after shoulder injection and 9% and 4% after sham hip injection. More patients in receiving steroid vs sham hip injection had osteonecrosis (P =.001 and P =.01 for each reviewer) and collapse (P =.01 and P =.01).

Given the findings of this study, the investigators suggest that “further evaluation of hip injectates and the injection population is warranted” in future clinical trials.

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Reference

Chang CY, Simeone FJ, Rafael J, et al.  Hip Steroid/Anesthetic Injections: Is there an Increased Incidence of hip osteoarthritis progression, femoral head osteonecrosis and collapse? Abstract SSK13‐07. Presented at: RSNA 2017. Chicago, IL.