Intra-Articular Cortisone Injection Has Limited Clinical Benefit for Non-Operative Treatment of Femoral Acetabular Impingement with Labral Pathology (SS-29)

Abstract

Intra-articular cortisone injection of the hip is commonly performed both as a confirmatory diagnostic test and also as a therapeutic treatment modality in patients with femoral acetabular impingement (FAI). However, to our knowledge, there is no published data documenting the clinical benefit of these injections in patients with FAI. Therefore, the purpose of our study is to assess the efficacy of intra-articular cortisone injection in patients with FAI and associated labral tear prior to hip arthroscopy. We hypothesize that intra-articular cortisone injection does not provide significant therapeutic benefit for the non-operative treatment of FAI with associated labral tear. The records of patients undergoing hip arthroscopy for FAI at our institution between January 2008 and October 2012 who agreed to participate in research were reviewed. A cohort of patients was identified that underwent a pre-operative ultrasound or fluoroscopic guided intra-articular cortisone injection. Inclusion criteria were a diagnosis of FAI with labral tear, Tonnis grade 0 or 1, and minimum 50% pain relief during the anesthetic phase of the intra-articular injection. Exclusion criteria were patients with concomitant osteoarthritis as defined as Tonnis grade 2 or 3. Numerical rating scale (NRS) pain scores were prospectively recorded pre-injection, immediately post-injection, and at 14 day follow-up. An absolute change of 2 points on the NRS score at 14 days was considered the minimal amount of clinically significant pain relief. The type of steroid used was documented. 35 patients met our inclusion criteria and included 29 females (83%) and 6 males (17%) with a mean age of 34.4 ± 12.9 years. 7 patients had Tonnis grade 0 (20%) and 28 had Tonnis grade 1 (80%). Patients received anesthetic combined with methylprednisolone (21 patients), triamcinolone (12 patients), or betamethasone (2 patients) during the intra-articular injection. Median pre-injection NRS score was 6 (range 2-10). Median immediate post-injection NRS score was 2 (range 0-6). Median 14 day post-injection NRS score was 4 (range 0-10). Median absolute change in NRS score at 14 days was 0 (range 0-8) with 23 patients reporting no change (66%) and 11 patients (31%) reporting a change of ≥ 2 points. There was no significant difference in pain reduction between the different steroid preparations. In patients with symptomatic FAI and associated labral pathology, our data indicates that intra-articular cortisone injection has limited clinical benefit in two-thirds of patients as a therapeutic non-operative treatment modality.