Outcomes of imaging-guided corticosteroid injections in hip and knee osteoarthritis patients: a systematic review

Use and safety of corticosteroid injections in joints and musculoskeletal soft tissue: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, and the International Pain and Spine Intervention Society

BACKGROUND

Intra-articular corticosteroid (IACS) injection and peri-articular corticosteroid injection are commonly used to treat musculoskeletal conditions. Results vary by musculoskeletal region, but most studies report short-term benefit with mixed results on long-term relief. Publications showed adverse events from single corticosteroid injections. Recommended effective doses were lower than those currently used by clinicians.

METHODS

Development of the practice guideline for joint injections was approved by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine and the participating societies. A Corticosteroid Safety Work Group coordinated the development of three guidelines: peripheral nerve blocks and trigger points; joints; and neuraxial, facet, and sacroiliac joint injections. The topics included safety of the technique in relation to landmark-guided, ultrasound-guided, or radiology-aided injections; effect of the addition of the corticosteroid on the efficacy of the injectate; and adverse events related to the injection. Experts on the topics were assigned to extensively review the literature and initially develop consensus statements and recommendations. A modified version of the US Preventive Services Task Force grading of evidence and strength of recommendation was followed. A modified Delphi process was adhered to in arriving at a consensus.

RESULTS

This guideline focuses on the safety and efficacy of corticosteroid joint injections for managing joint chronic pain in adults. The joints that were addressed included the shoulder, elbow, hand, wrist, hip, knee, and small joints of the hands and feet. All the statements and recommendations were approved by all participants and the Board of Directors of the participating societies after four rounds of discussion. There is little evidence to guide the selection of one corticosteroid over another. Ultrasound guidance increases the accuracy of injections and reduces procedural pain. A dose of 20 mg triamcinolone is as effective as 40 mg for both shoulder IACS and subacromial subdeltoid bursa corticosteroid injections. The commonly used dose for hip IACS is 40 mg triamcinolone or methylprednisolone. Triamcinolone 40 mg is as effective as 80 mg for knee IACS. Overall, IACS injections result in short-term pain relief from a few weeks to a few months. The adverse events include an increase in blood glucose, adrenal suppression, detrimental effect on cartilage lining the joint, reduction of bone mineral density, and postoperative joint infection.

CONCLUSIONS

In this practice guideline, we provided specific recommendations on the role of corticosteroids in joint, bursa, and peritendon injections for musculoskeletal pain.

Effectiveness of ultrasound-guided hip injections on pain and functioning in patients with hip osteoarthritis: A systematic review

BACKGROUND

Osteoarthritis is the most common form of arthritis, causing pain, functional disability, and a reduction in terms of quality of life. Minimally invasive treatments like intra-articular hip injections are a therapeutic option and ultrasound guidance might improve the results of these injections.

OBJECTIVE

To summarize the evidence about the effectiveness of ultrasound-guided hip injections in terms of pain and functioning in patients affected by hip osteoarthritis.

METHODS

A systematic search of the literature was performed on three electronic databases: PubMed, Cochrane and PEDro, using a specific search strategy. We evaluated for inclusion all articles according to the following participants, intervention, comparison, and outcomes (PICO) model: P) Population: human patients affected by hip osteoarthritis; I) Intervention: intra-articular hip injections performed with a ultrasound-guidance; C) Comparator: sham therapy or every other conservative or oral, non-invasive, minimally invasive or surgical technique; O) Outcome measures: pain assessed by Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS); functional outcomes.

RESULTS

At the end of the search, 43 articles were included in the review. Several drugs have been considered in the included studies: hyaluronic acid, platelet-rich plasma, corticosteroids, micro-fragmented adipose tissue, bone marrow concentrates, amniotic suspension allograft.

CONCLUSION

Ultrasound-guided injections of hyaluronic acid might be effective on pain relief and functioning in patients affected by hip osteoarthritis. Also, other rehabilitative infiltrative techniques (i.e., corticosteroids and platelet-rich plasma) showed a positive effect in the short-term period.

A Tale of Bilateral Rapidly Progressive Osteoarthritis of the Hip-It Is Not Always the Steroid Injection: A Case Report

ABSTRACT

Rapidly progressive osteoarthritis of the hip is an unusual subset of hip osteoarthritis in which a >2 mm/yr rate of joint space narrowing occurs. Rapidly progressive osteoarthritis of the hip has been associated with intra-articular steroid injection, with the incidence of rapidly progressive osteoarthritis of the hip after intra-articular steroid injection ranging from 2.8% to 21%. The occurrence of rapidly progressive osteoarthritis of the hip unrelated to intra-articular steroid injection is rare, and not frequently reported. This report presents a unique case of rapidly progressive osteoarthritis of the hip in the bilateral hips of one patient. The first hip developed rapidly progressive osteoarthritis of the hip within 6 mos after an intra-articular steroid injection. Three years later, the second hip developed rapidly progressive osteoarthritis of the hip within 4 mos without any injection or use of systemic steroid medication. The etiology of rapidly progressive osteoarthritis of the hip in the absence of intra-articular steroid injection is unclear, and this case presents the opportunity to observe the development of rapidly progressive osteoarthritis of the hip due to different causes within the same individual.