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. 1997 Aug;56(8):476–480. doi: 10.1136/ard.56.8.476

Radiographic patterns and response to corticosteroid hip injection

M Plant 1, A Borg 1, K Dziedzic 1, J Saklatvala 1, P Dawes 1
PMCID: PMC1752427  PMID: 9306870

Abstract

OBJECTIVES—A prospective, open study of corticosteroid hip injection (CHI) was performed to determine if different radiological patterns of arthritis vary in their response.
METHODS—Forty five patients (15 with rheumatoid arthritis, 27 with osteoarthritis, and three with anklyosing spondylitis) underwent hip injection with 80 mg methyl- prednisolone and lignocaine under x ray control. Outcome was assessed at two, 12, and 26 weeks for pain, range of hip movement, and graded functional questionnaire. Patients estimated their pain in four components, night pain, rest pain, weight bearing, and referred pain, each measured by 10 cm visual analogue score and summed to give a total score out of 40 cm. Hip radiographs were evaluated blindly for pattern and severity of arthritis, as well as for progression between 0 and 26 weeks.
RESULTS—Median total pain score decreased from 29 cm at baseline to 22 cm at two weeks (p=0.0001), 24 cm at 12 weeks (p=0.03), but had returned nearly to baseline by 26 weeks (25 cm, p=0.3). Greatest improvement was seen for night pain. Mean range of internal rotation increased from 16 to 28 degrees at two weeks (p=0.03) and 23 degrees at 12 weeks (p=0.06). Functional ability did not change. Hips with an atrophic pattern of arthritis on plain radiography gained negligible pain relief at two weeks compared with hips with a hypertrophic or mixed bone response (p=0.04). The degree of pain relief was similar in patients with OA and RA, and was not influenced by radiographic severity or by the direction of migration of the femoral head.
CONCLUSION—Pain and internal rotation improve for up to 12 weeks after CHI. CHI offers a useful and safe therapeutic option for patients with hip arthritis, with the exception of those with a purely atrophic radiological pattern.



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Figure 1  .

Figure 1  

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Total hip pain after corticosteroid hip injection. Total hip pain by visual analogue scale (max = 40 cm) is shown in 30 patients followed up for six months after injection of 80 mg methylprednisolone under x ray guidance. The middle bar represents the median: the box represents the 25% and 75% quartiles: the whiskers represent the 10% and 90% centiles. p Values are for comparison with baseline pain scores (Wilcoxon signed rank test).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altman R. D., Fries J. F., Bloch D. A., Carstens J., Cooke T. D., Genant H., Gofton P., Groth H., McShane D. J., Murphy W. A. Radiographic assessment of progression in osteoarthritis. Arthritis Rheum. 1987 Nov;30(11):1214–1225. doi: 10.1002/art.1780301103. [DOI] [PubMed] [Google Scholar]
  2. Chakravarty K., Pharoah P. D., Scott D. G. A randomized controlled study of post-injection rest following intra-articular steroid therapy for knee synovitis. Br J Rheumatol. 1994 May;33(5):464–468. doi: 10.1093/rheumatology/33.5.464. [DOI] [PubMed] [Google Scholar]
  3. Dieppe P. Management of osteoarthritis of the hip and knee joints. Curr Opin Rheumatol. 1993 Jul;5(4):487–493. doi: 10.1097/00002281-199305040-00014. [DOI] [PubMed] [Google Scholar]
  4. Duthie R. B., Harris C. M. A radiographic and clinical survey of the hip joint in sero-positive rheumatoid arthritis. Acta Orthop Scand. 1969;40(3):346–364. doi: 10.3109/17453676908989513. [DOI] [PubMed] [Google Scholar]
  5. Flanagan J., Casale F. F., Thomas T. L., Desai K. B. Intra-articular injection for pain relief in patients awaiting hip replacement. Ann R Coll Surg Engl. 1988 May;70(3):156–157. [PMC free article] [PubMed] [Google Scholar]
  6. Földes K., Bálint P., Gaál M., Buchanan W. W., Bálint G. P. Nocturnal pain correlates with effusions in diseased hips. J Rheumatol. 1992 Nov;19(11):1756–1758. [PubMed] [Google Scholar]
  7. Gaffney K., Ledingham J., Perry J. D. Intra-articular triamcinolone hexacetonide in knee osteoarthritis: factors influencing the clinical response. Ann Rheum Dis. 1995 May;54(5):379–381. doi: 10.1136/ard.54.5.379. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gray R. G., Gottlieb N. L. Intra-articular corticosteroids. An updated assessment. Clin Orthop Relat Res. 1983 Jul-Aug;(177):235–263. [PubMed] [Google Scholar]
  9. Gray R. G., Tenenbaum J., Gottlieb N. L. Local corticosteroid injection treatment in rheumatic disorders. Semin Arthritis Rheum. 1981 May;10(4):231–254. doi: 10.1016/0049-0172(81)90001-9. [DOI] [PubMed] [Google Scholar]
  10. Hastings D. E., Parker S. M. Protrusio acetabuli in rheumatoid arthritis. Clin Orthop Relat Res. 1975 May;(108):76–83. doi: 10.1097/00003086-197505000-00012. [DOI] [PubMed] [Google Scholar]
  11. Jones A., Doherty M. Intra-articular corticosteroids are effective in osteoarthritis but there are no clinical predictors of response. Ann Rheum Dis. 1996 Nov;55(11):829–832. doi: 10.1136/ard.55.11.829. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. KELLGREN J. H., LAWRENCE J. S. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957 Dec;16(4):494–502. doi: 10.1136/ard.16.4.494. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. LEVEAUX V. M., QUIN C. E. Local injection of hydrocortisone and procaine in osteo-arthritis of the hip joint. Ann Rheum Dis. 1956 Dec;15(4):330–337. doi: 10.1136/ard.15.4.330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Larsen A., Dale K., Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 1977 Jul;18(4):481–491. doi: 10.1177/028418517701800415. [DOI] [PubMed] [Google Scholar]
  15. Lawrence J. S., Bremner J. M., Bier F. Osteo-arthrosis. Prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis. 1966 Jan;25(1):1–24. [PMC free article] [PubMed] [Google Scholar]
  16. Ledingham J., Dawson S., Preston B., Milligan G., Doherty M. Radiographic patterns and associations of osteoarthritis of the hip. Ann Rheum Dis. 1992 Oct;51(10):1111–1116. doi: 10.1136/ard.51.10.1111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Ledingham J., Dawson S., Preston B., Milligan G., Doherty M. Radiographic progression of hospital referred osteoarthritis of the hip. Ann Rheum Dis. 1993 Apr;52(4):263–267. doi: 10.1136/ard.52.4.263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. McGoldrick F., O'Brien T. M. Osteoarthritis of the hip and Heberden's nodes. Ann Rheum Dis. 1989 Jan;48(1):53–55. doi: 10.1136/ard.48.1.53. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Menkes C. J., Decraemere W., Postel M., Forest M. Chondrocalcinosis and rapid destruction of the hip. J Rheumatol. 1985 Feb;12(1):130–133. [PubMed] [Google Scholar]
  20. Resnick D. Patterns of migration of the femoral head in osteoarthritis of the hip. Roentgenographic-pathologic correlation and comparison with rheumatoid arthritis. Am J Roentgenol Radium Ther Nucl Med. 1975 May;124(1):62–74. doi: 10.2214/ajr.124.1.62. [DOI] [PubMed] [Google Scholar]
  21. Solomon L. Patterns of osteoarthritis of the hip. J Bone Joint Surg Br. 1976 May;58(2):176–183. doi: 10.1302/0301-620X.58B2.932079. [DOI] [PubMed] [Google Scholar]
  22. Thomas R. H., Resnick D., Alazraki N. P., Daniel D., Greenfield R. Compartmental evaluation of osteoarthritis of the knee. A comparative study of available diagnostic modalities. Radiology. 1975 Sep;116(3):585–594. doi: 10.1148/116.3.585. [DOI] [PubMed] [Google Scholar]
  23. Wilcock G. K. The prevalence of osteoarthrosis of the hip requiring total hip replacement in the elderly. Int J Epidemiol. 1979 Sep;8(3):247–250. doi: 10.1093/ije/8.3.247. [DOI] [PubMed] [Google Scholar]

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