Symposium: evidence for the use of intra-articular cortisone or hyaluronic acid injection in the hip.

Sivashankar Chandrasekaran,Benjamin G Domb,S Pavan Vemula,Parth Lodhia,Carlos Suarez-Ahedo,Timothy J Martin

doi:10.1093/jhps/hnv020

Sivashankar Chandrasekaran, Benjamin G Domb + Show 4 more

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https://doi.org/10.1093/jhps/hnv020

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Abstract

The primary purpose of this review article is to discuss the role of diagnostic, corticosteroid, hyaluronic acid (HA) and platelet rich plasma (PRP) in the treatment of osteoarthritis (OA) and femoroacetabular impingement (FIA). These treatments play an important biological role in the non-operative management of these conditions. Two independent reviewers performed an search of PubMed for articles that contained at least one of the following search terms pertaining to intra-articular hip injection—local anaesthetic, diagnostic, ultrasound, fluoroscopic, image guided, corticosteroid, HA, PRP, OA, labral tears and FAI. Seventy-two full text articles were suitable for inclusion. There were 18 articles addressing the efficacy of diagnostic intra-articular hip injections. With respect to efficacy in OA there were 25 articles pertaining to efficacy of corticosteroid, 22 of HA and 4 of PRP. There were three articles addressing the efficacy of biologics in FAI. Diagnostic intra-articular hip injections are sensitive and specific for differentiating between intra-articular, extra-articular and spinal causes of hip symptoms. Ultrasound and fluoroscopy improves the precision of intra-articular positioning of diagnostic injections. Corticosteroids are more effective than HA and PRP in alleviating pain from hip OA. A higher dose of corticosteroids produces a longer benefit but volume of injection has no significant effect. Intra-articular corticosteroids do not increase infection rates of subsequent arthroplasty. There is currently limited evidence to warrant the routine use of therapeutic injections in the management of labral tears and FIA.

Highlights

Intra-articular and extra-articular injections around the hip joint are commonly used as both a diagnostic and therapeutic modality [1,2,3]
The primary purpose of this review article is to discuss the role of diagnostic, corticosteroid, hyaluronic acid (HA) and platelet rich plasma (PRP) in the treatment of osteoarthritis (OA) and femoroacetabular impingement (FIA)
Two independent reviewers performed an search of PubMed for articles that contained at least one of the following search terms pertaining to intra-articular hip injection—local anaesthetic, diagnostic, ultrasound, fluoroscopic, image guided, corticosteroid, HA, PRP, OA, labral tears and femoroacetabular impingement (FAI)

Summary

Introduction

Intra-articular and extra-articular injections around the hip joint are commonly used as both a diagnostic and therapeutic modality [1,2,3]. There have been discrepancies with respect to the efficacy of several of the biologics used in these injections [4,5,6] These discrepancies exist despite the existence of level 1 double blinded randomized control trials. It is important for the practicing orthopaedic surgeon to have current knowledge of the literature regarding the efficacy of many of these biologics so that patients may be informed appropriately about the risks and benefits of receiving injections around the hip joint. The benefit of non-image guided injections based on anatomical landmarks is the ability to perform them at initial consultation without the additional cost and required availability of ultrasound or fluoroscopy [14, 15], while disadvantages include reduced precision [16].

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