Abstract
IntroductionOur objective was to assess the efficacy of ultrasound-guided hip injections performed by emergency physicians (EPs) for the treatment of chronic hip pain in an outpatient clinic setting.MethodsPatients were identified on a referral basis from the orthopedic chronic pain clinic. The patient population was either identified as having osteoarthritis of the hip, osteonecrosis of varying etiologies, post-traumatic osteoarthritis of the hip, or other non-infectious causes of chronic hip pain. Patients had an ultrasound-guided hip injection of 4ml of 0.5% bupivacaine and 1ml of triamcinolone acetate (40mg/1ml). Emergency medicine resident physicians under the supervision of an attending EP performed all injections. Pain scores were collected using a Likert pain scale from patients prior to the procedure, and 10 minutes post procedure and at short-term follow-up of one week and one month. The primary outcome was patient-reported pain score on a Likert pain scale at one week.ResultsWe performed a total of 47 ultrasound-guided intra-articular hip injections on 44 subjects who met inclusion criteria. Three subjects received bilateral injections. Follow-up data were available for 42/47 (89.4%) hip injections at one week and 40/47 (85.1%) at one month. The greatest improvement was at 10 minutes after injection with a mean decrease in Likert pain score from pre-injection baseline of 5.57 (95% CI, 4.76–6.39). For the primary outcome at one week, we found a mean decrease in Likert pain score from pre-injection baseline of 3.85 (95% CI, 2.94–4.75). At one month we found a mean decrease in Likert pain score of 1.8 (95% CI, 1.12–2.53). There were no significant adverse outcomes reported.ConclusionUnder the supervision of an attending EP, junior emergency medicine resident physicians can safely and effectively inject hips for chronic pain relief in an outpatient clinical setting using ultrasound guidance.
Highlights
Our objective was to assess the efficacy of ultrasound-guided hip injections performed by emergency physicians (EPs) for the treatment of chronic hip pain in an outpatient clinic setting
Our study demonstrates that emergency medicine (EM) trainees can effectively perform US-guided corticosteroid hip injections as a method for the treatment of chronic hip pain
Our analysis demonstrates that US-guided corticosteroid intra-articular hip injection as performed by EM trainees is effective at decreasing chronic hip pain acutely and over a one-week period
Summary
Our objective was to assess the efficacy of ultrasound-guided hip injections performed by emergency physicians (EPs) for the treatment of chronic hip pain in an outpatient clinic setting. Hip pain is a common complaint with a wide variety of etiologies. These range from the benign and chronic, such as osteoarthritis, to the acutely joint-threatening, such as septic arthritis. Chronic hip pain has an estimated prevalence of up to six percent and is a common cause of pain in patients presenting to orthopedic clinics and emergency departments (EDs).. Joint injections with corticosteroids are first-line recommended therapy by the American College of Rheumatology, and the European League Against Rheumatism recommends intraarticular hip injections for flares of chronic hip osteoarthritis.. Chronic hip pain has an estimated prevalence of up to six percent and is a common cause of pain in patients presenting to orthopedic clinics and emergency departments (EDs). Joint injections with corticosteroids are first-line recommended therapy by the American College of Rheumatology, and the European League Against Rheumatism recommends intraarticular hip injections for flares of chronic hip osteoarthritis. A 2007 randomized controlled trial has demonstrated clear efficacy without any complications.
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