Department of Radiology and Biomedical Imaging, University of California, 500 Parnassus Avenue, San Francisco, CA, 94143, USA.
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Skeletal Radiol. 2021 Jul;50(7):1347-1357. doi: 10.1007/s00256-020-03673-9. Epub 2020 Nov 27.
To investigate the associations between clinical, procedural, and radiographic factors and outcomes of steroid hip injections, including long-term and immediate pain reduction, time to arthroplasty, time to reinjection, and the total number of injections.
All intra-articular anesthetic and steroid injections of the hip under fluoroscopic guidance between January 2014 and March 2016 were retrospectively reviewed. Hip radiographs were scored using the Kellgren-Lawrence (KL) and Osteoarthritis Research Society International (OARSI) scores. Immediate pain relief and response were evaluated using a change in visual analog scale and OMERACT-OARSI criteria respectively. Long-term pain relief was evaluated at 2‑7 months after injection by reviewing the medical records. Correlation between patient characteristics, procedural variations, and radiographic factors with injection outcomes was analyzed by using linear and logistic regression models.
Of 361 injections, 79.8% showed an immediate pain response and 32.7% had subjective long-term pain relief (> 2 months). There was no significant correlation between immediate pain relief and response with long-term pain relief and other outcomes. Older age and higher KL score, OARSI-central joint space narrowing (JSN), and inferior acetabular osteophyte were correlated with long-term pain relief (p = 0.01‑0.03). Higher KL and OARSI grades, particularly JSN, were significantly correlated with increased immediate pain relief and total number of injections but decreased time to arthroplasty. Baseline pain positively correlated with immediate pain response (p < 0.001).
Older patients with higher grades of radiographic OA and high baseline pain were good candidates for steroid injections, particularly for those patients awaiting hip arthroplasty.
探讨临床、操作和影像学因素与类固醇髋关节注射的结果之间的关系，包括长期和短期疼痛缓解、关节置换时间、再次注射时间以及总注射次数。
回顾性分析 2014 年 1 月至 2016 年 3 月期间在透视引导下进行的所有关节内麻醉和类固醇髋关节注射。使用 Kellgren-Lawrence（KL）和骨关节炎研究协会国际（OARSI）评分对髋关节 X 线片进行评分。使用视觉模拟量表（VAS）变化和 OMERACT-OARSI 标准分别评估即时疼痛缓解和反应。通过查阅病历，在注射后 2-7 个月评估长期疼痛缓解情况。使用线性和逻辑回归模型分析患者特征、操作变化和影像学因素与注射结果之间的相关性。
在 361 次注射中，79.8%表现出即时疼痛反应，32.7%有主观长期疼痛缓解（>2 个月）。即时疼痛缓解和反应与长期疼痛缓解和其他结果之间无显著相关性。年龄较大、KL 评分较高、OARSI 中央关节间隙狭窄（JSN）和髋臼下骨赘与长期疼痛缓解相关（p=0.01-0.03）。较高的 KL 和 OARSI 分级，尤其是 JSN，与即时疼痛缓解和总注射次数增加相关，但与关节置换时间缩短相关。基线疼痛与即时疼痛反应呈正相关（p<0.001）。
年龄较大、影像学 OA 分级较高且基线疼痛较高的患者是类固醇注射的良好候选者，特别是那些等待髋关节置换的患者。
