Steroid injection for osteoarthritis of the hip: A randomized, double‐blind, placebo‐controlled trial

Abstract

Objective. To determine the efficacy of fluoroscopically guided corticosteroid injection for hip osteoarthritis (OA) in a randomized, double-blind, placebocontrolled trial.Methods. Fifty-two patients with symptomatic hip OA were randomly allocated to receive placebo (10 mg bipuvicaine, 2 ml saline) (n ‫؍‬ 21) or corticosteroid treatment (10 mg bipuvicaine, 40 mg triamcinolone hexacetonide) (n ‫؍‬ 31). Patients were followed up for 1, 2, 3, and 6 months. The primary outcome measure was the pain improvement response, defined as a 20% decrease in the Western Ontario and McMaster Universities OA Index (WOMAC) pain score (on 5 100-mm visual analog scales [VAS]) (WOMAC20) from baseline to 2 months postinjection. Secondary outcomes were a 50% decrease in the WOMAC pain score (WOMAC50), changes in other WOMAC subscale scores, patient's global assessment of health (on a 100-mm VAS), and Short Form 36 (SF-36) quality of life indices. Analyses were based on the intent-to-treat principle.Results. The mean WOMAC pain score fell 49.2% (decreasing from 310.1 mm to 157.4 mm) at 2 months postinjection in patients receiving corticosteroid, compared with a decrease of 2.5% (from 314.3 mm to 306.5 mm) in the placebo group (P < 0.0001). The proportion of WOMAC20 responders at 2 months' followup was significantly higher in the corticosteroid group (67.7%) compared with the placebo group (23.8%) (P ‫؍‬ 0.004); similar proportions of WOMAC50 responders were observed between groups (61.3% in the corticosteroid group versus 14.3% in the placebo group; P ‫؍‬ 0.001). Response differences were maintained at 3 months' followup (58.1% responders in the corticosteroid group versus 9.5% responders in the placebo group; P ‫؍‬ 0.004). Significant differences in the WOMAC stiffness and physical function scores (P < 0.0001), patient's global health scores (P ‫؍‬ 0.005), and SF-36 physical component scores (P ‫؍‬ 0.04) were observed, with patients in the corticosteroid group showing greater improvements. There were no differences in the frequency of adverse events between groups.Conclusion. This placebo-controlled trial confirms that corticosteroid injection can be an effective treatment of pain in hip OA, with benefits lasting up to 3 months in many cases. Future studies should address questions related to the benefits of repeated steroid injection and the effects of this treatment on disease modification.Osteoarthritis (OA) affects all vertebrates, and the prevalence of the disease increases exponentially with age. Estimates of the prevalence of hip OA in humans range from 2% at age 35 years to 35% at age 85 years or older (1), and autopsies have shown that cartilage degeneration can be detected in patients as early as the second decade of life (2). A disease prevalence estimate of 3% among North Americans older than age 55 years has been commonly quoted, but this may well be an underestimate of the true burden of hip OA in the general population (3,4). The prevalence of the disease has significant fiscal implications, since it has

Increased Chondrocyte Death after Steroid and Local Anesthetic Combination

“…The rationale would be that the local anesthetic component acts quickly after administration, it provides fast alleviation of pain, and it may last for up to the point when the steroid component starts to exert its effect. Although it has been reported that steroids and local anesthetics have a strong cytotoxic effect on chondrocytes, concomitant administration of corticosteroids and local anesthetics in osteoarthritis is still a widely used and investigated method [12,27,32,[45][46][47]. Similar to our findings, a recent study revealed a methylprednisolone-lidocaine combination showed a cytotoxic effect on bovine chondrocytes cultured in alginate beads [46].…”

“…Intraarticular injection of corticosteroid is an effective and common treatment for osteoarthritis, although clinical evidence suggests it provides a relatively short-lived benefit in pain relief [16,21,26,27,37,42,44,47]. One study suggested certain dosages of corticosteroids used clinically as antiinflammatory drugs for osteoarthritis are harmful to articular cartilage [15], whereas lower dosages are reportedly chondroprotective and delay progression of cartilage lesions [8,28,36,38,43].…”

“…In 1956, Leveaux and Quin were possibly the first who investigated hydrocortisone and procaine combined injections for osteoarthritis [31]. Since then, many studies have been published that focus on the overall effects of corticosteroid and local anesthetic drugs for pain relief, improvement in ROM, or functional ability [12,14,27,32,33,40,41,47,52,54]. Numerous studies report short-term intraarticular corticosteroid injection for the treatment of osteoarthritis [1,2,4,8,16,21,42,44].…”

Effect of hyaluronic acid in symptomatic hip osteoarthritis: A multicenter, randomized, placebo‐controlled trial

“…Qvistgaard et al (15) found that the mean (range) within-group difference in pain score (on walking) on a 100-mm VAS on day 90 after saline injection was Ϫ5 (Ϫ13, 2) (15). In another RCT that compared the efficacy of a single injection of a steroid with a single injection of placebo, the proportion of responders, defined according to the OMERACT-OARSI criteria, was 4.8% in the placebo group 3 months after treatment (26). In view of these results, the extent of the placebo response following IA injections could be lower in hip OA than in knee OA, as was also suggested by a recent meta-analysis that evaluated the placebo effect and its determinants in OA (27).…”

Interventional MSK procedures: the hip

“…Only four randomized, controlled trials of intra-articular corticosteroid injections in hip osteoarthritis have been reported via fluoroscopic or ultrasound guidance. [1][2][3][4] In comparison to placebo, saline or local anaesthetic injections, corticosteroid injections have demonstrated a definite short-lived effect on acute pain and improvement of the range of motion in osteoarthritis, but with no significant persistent effect at the 3-month follow-up in most studies. Intra-articular injection of hyaluronic acid is still controversial in the management of hip osteoarthritis (OA), as its efficacy has not been clearly established.…”