Department of Radiology, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk, United Kingdom.
Skeletal Radiol. 2012 Aug;41(8):981-5. doi: 10.1007/s00256-011-1290-4. Epub 2011 Nov 10.
The diagnosis of hip osteoarthritis is often complicated by co-existing pathology in the knee and spine, and mismatch between clinical and radiological signs. Temporary pain relief from a local anaesthetic injection into the hip joint has been reported to help localise symptoms, reducing the risk of unnecessary surgery being performed. We hypothesize that good surgical outcome is predicted by good analgesia following diagnostic injection, and that alternative pathology is present when there is no response to injection.
Data were analysed from a prospective database of 163 consecutive patients who underwent diagnostic hip injection for possible osteoarthritis. We recorded result of injection and whether hip arthroplasty was performed. A good outcome to surgery was defined as subsequent pain relief without significant residual symptoms.
A total of 138 patients were suitable for inclusion in the study. Fifty-eight patients had hip arthroplasty following a good response to diagnostic injection. Of these 54 had a good outcome following surgery (93%). There was also a quantitative improvement in pain and function in these patients as measured by 1 year post-operative and pre-operative Harris hip scores (P < 0.0001). A total of 44/49 patients had no surgery following no response to injection. A clear alternative diagnosis to hip osteoarthritis was made in 40 of these patients (91%).
Diagnostic ultrasound-guided local anaesthetic injection of the hip joint is a useful test in confirming hip pathology. Complete relief of hip pain following intracapsular injection of local anaesthetic is associated with good surgical outcome following joint replacement.
髋关节炎的诊断常常因膝关节和脊柱并存的病变以及临床和影像学表现不匹配而变得复杂。髋关节局部麻醉注射后暂时缓解疼痛已被报道有助于定位症状，降低不必要手术的风险。我们假设诊断性注射后良好的镇痛效果预示着良好的手术结果，而当注射无反应时，则存在其他病变。
我们对 163 例连续接受髋关节诊断性注射以诊断可能的骨关节炎的患者的前瞻性数据库中的数据进行了分析。我们记录了注射结果和是否进行髋关节置换术。手术的良好结果定义为随后的疼痛缓解而无明显残留症状。
共有 138 例患者适合纳入研究。58 例患者在诊断性注射反应良好后接受髋关节置换术。这些患者中有 54 例（93%）在手术后有良好的结果。这些患者的疼痛和功能也有明显改善，通过术后 1 年和术前 Harris 髋关节评分进行测量（P<0.0001）。49 例患者中有 44 例在注射无反应后没有进行手术。在这些患者中有 40 例（91%）明确了髋关节炎以外的其他诊断。
髋关节超声引导下局部麻醉注射是一种有用的髋关节病变确认测试。髋关节囊内局部麻醉注射后髋关节疼痛完全缓解与关节置换术后良好的手术结果相关。
