Hess Shane R, O'Connell Robert S, Bednarz Christopher P, Waligora Andrew C, Golladay Gregory J, Jiranek William A
The CORE Institute, Phoenix, AZ, USA.
Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
Arthroplast Today. 2018 May 7;4(2):205-209. doi: 10.1016/j.artd.2017.12.002. eCollection 2018 Jun.
To assess the relationship between rapidly destructive osteoarthritis (RDOA) of the hip and intra-articular steroid injections.
Coding records from 2000 to 2013 were used to identify all subjects who had a fluoroscopy-guided intra-articular hip injection to treat pain associated with primary osteoarthritis. Radiographic measurements from preinjection and postinjection imaging were evaluated with Luquesne's classification of RDOA to determine diagnosis (greater than 50% joint space narrowing or greater than 2 mm of cartilage loss in 1 year with no other forms of destructive arthropathy). Demographic information, health characteristics, and number of injections were collected and analyzed as other potential explanatory variables. Patient outcome assessed by need for total hip arthroplasty (THA) after injection was also recorded.
One hundred twenty-nine injection events met the inclusion criteria in a total of 109 patients. From this sample, 23 cases of RDOA were confirmed representing a 21% incidence of RDOA. Twenty-one of the patients (91%) with RDOA had a THA at a median time of 10.2 months (interquartile range: 6.5-11.2) compared with 27 (31%) of those without RDOA at a median time of 24.9 months (interquartile range: 15.3-65.3). Older patients, patients with more severe osteoarthritis, and patients who identified themselves as white were more likely to have a diagnosis of RDOA ( = .008; = .040; = .009, respectively).
The potential for RDOA and faster progression to THA raises questions about the use of intra-articular steroid injections for hip osteoarthritis and should be discussed with patients. Additional studies are needed to define a true relationship.
评估髋关节快速破坏性骨关节炎（RDOA）与关节内注射类固醇之间的关系。
使用2000年至2013年的编码记录来识别所有接受荧光透视引导下髋关节内注射以治疗原发性骨关节炎相关疼痛的受试者。根据RDOA的卢克森分类法评估注射前和注射后影像学的放射学测量结果，以确定诊断（1年内关节间隙狭窄大于50%或软骨损失大于2mm，且无其他形式的破坏性关节病）。收集人口统计学信息、健康特征和注射次数，并作为其他潜在解释变量进行分析。还记录了注射后通过全髋关节置换术（THA）需求评估的患者结局。
109例患者中共有129次注射事件符合纳入标准。在该样本中，确诊23例RDOA，RDOA发病率为21%。21例（91%）RDOA患者接受THA的中位时间为10.2个月（四分位间距：6.5 - 11.2），而无RDOA的患者中有27例（31%）接受THA的中位时间为24.9个月（四分位间距：15.3 - 65.3）。老年患者、骨关节炎更严重的患者以及自认为是白人的患者更有可能被诊断为RDOA（分别为P = .008；P = .040；P = .009）。
RDOA的可能性以及更快进展至THA引发了关于髋关节骨关节炎使用关节内注射类固醇的问题，应与患者进行讨论。需要进一步研究来确定真正的关系。
