Angotti Morgan L, Burnett Robert A, Khalid Syed, Terhune E Bailey, Della Valle Craig J
Midwest Orthopaedics at Rush LLC, Chicago, IL, USA.
Hip Int. 2023 Sep;33(5):800-805. doi: 10.1177/11207000221107225. Epub 2022 Jun 19.
Intra-articular corticosteroid injections are commonly administered for hip pain. However, guidelines are conflicting on their efficacy, particularly in patients without arthritis. This study assessed for an association of corticosteroid injections and the incidence of total hip arthroplasty at 5 years.
Patients with a diagnosis of hip pain without femoroacetabular osteoarthritis who were administered an intra-articular corticosteroid injection of the hip within a 2-year period were identified from the Mariner PearlDiver database. Patient were matched to patients with a diagnosis of hip pain who did not receive an injection. 5-year incidence of total hip arthroplasty was compared between matched patients who received an intra-articular corticosteroid injection and those who did not.
2,540,154 patients diagnosed with hip pain without femoroacetabular arthritis were identified. 25,073 (0.9%) patients received a corticosteroid injection and were matched to an equal number of control patients. The incidence of total hip arthroplasty (THA) at 5-year-follow up was significantly higher for the corticosteroid cohort compared to controls (1.1% vs. 0.5%; < 0.001). The incidence and risk of THA increased along with number of injections (1 injection: 0.8%, OR 1.37; 95% CI, 1.34-1.42; < 0.001, 2 injections: 1.1%; OR 1.45; CI, 1.40-1.50; < 0.001, ⩾3 injections: 1.5%; OR 1.48; CI, 1.40-1.56; < 0.001).
There may be a dose-dependent association of corticosteroid injections and a greater risk of total hip arthroplasty at 5 years. These results along with the conflicting guidelines on the efficacy of intra-articular steroids for hip pain should prompt physicians to consider osteoarthritis progression that may occur in the setting of corticosteroid injections in non-arthritic hips.
关节内注射皮质类固醇常用于治疗髋部疼痛。然而，关于其疗效的指南存在冲突，尤其是在非关节炎患者中。本研究评估了皮质类固醇注射与5年时全髋关节置换术发生率之间的关联。
从水手珍珠潜水员数据库中识别出在2年期间接受过髋关节内皮质类固醇注射且诊断为髋部疼痛但无股骨髋臼骨关节炎的患者。将这些患者与诊断为髋部疼痛但未接受注射的患者进行匹配。比较接受关节内皮质类固醇注射的匹配患者与未接受注射的匹配患者5年时全髋关节置换术的发生率。
共识别出2540154例诊断为髋部疼痛但无股骨髋臼关节炎的患者。25073例（0.9%）患者接受了皮质类固醇注射，并与同等数量的对照患者进行匹配。与对照组相比，皮质类固醇队列在5年随访时全髋关节置换术（THA）的发生率显著更高（1.1%对0.5%；P<0.001）。THA的发生率和风险随着注射次数的增加而增加（1次注射：0.8%，OR 1.37；95%CI，1.34 - 1.42；P<0.001，2次注射：1.1%；OR 1.45；CI，1.40 - 1.50；P<0.001，≥3次注射：1.5%；OR 1.48；CI，1.40 - 1.56；P<0.001）。
皮质类固醇注射与5年时全髋关节置换术风险增加之间可能存在剂量依赖性关联。这些结果以及关于关节内类固醇治疗髋部疼痛疗效的相互冲突的指南，应促使医生考虑在非关节炎髋关节进行皮质类固醇注射时可能发生的骨关节炎进展。
