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08-04-2022 | Rheumatology | News | Article

Ultrasound-guided hip injection may benefit people with hip osteoarthritis

Author: Laura Cowen

medwireNews: A single ultrasound-guided corticosteroid and local anesthetic intra-articular hip injection offers greater pain relief to people with moderate hip osteoarthritis than the best current treatment (BCT) of advice and education, research suggests.

The effect lasted for at least 2 months and was accompanied by improved function, report Zoe Paskins (Keele University, UK) and co-authors in The BMJ.

They say their “findings provide evidence to inform international guidelines and offer important choice to patients, who often believe their treatment options are limited.”

The Hip Injection Trial included 199 adults aged 40 years and older (mean 62.8 years, 57% women) with hip osteoarthritis and at least moderate pain (mean 5.7 points on a scale of 0–10).

They were randomly assigned to receive BCT (n=67), BCT plus an ultrasound-guided intra-articular hip injection of triamcinolone acetonide 40 mg and 4 mL 1% lidocaine hydrochloride (n=66), or BCT plus ultrasound-guided intra-articular hip injection of 5 mL 1% lidocaine (n=66).

During 6 months of follow-up, the mean pain score was 5.6 points in the BCT group versus 4.2 and 4.7 points in the BCT plus triamcinolone–lidocaine and BCT plus lidocaine groups, respectively.

The overall mean difference of 1.43 points between the BCT and BCT plus triamcinolone–lidocaine groups was statistically and clinically significant but varied over time, the researchers note.

The mean difference in pain between the two groups was a significant 3.17 and 1.81 points at 2 weeks and 2 months, respectively, but a nonsignificant 0.86 and 0.12 points at 4 and 6 months, respectively.

Among the secondary outcomes measured, Paskins and team observed significantly greater overall improvements with the BCT plus triamcinolone–lidocaine injection versus BCT alone in pain and physical function (WOMAC, Short Form-12 physical component score), pain self-efficacy, illness perceptions, quality of life (QoL; EQ-5D-5L), and work presenteeism and performance.

The magnitude of these improvements also generally dwindled with time, however.

The investigators say that “the study was probably underpowered to assess differences between the two injection groups, and also to detect significant interactions between baseline moderators of treatment and outcomes.”

Nonetheless, they report that there was no significant difference between the two injection groups in overall pain during follow-up but there were differences in favor of BCT plus triamcinolone–lidocaine injection in a number of the secondary outcomes, including pain self-efficacy, illness perceptions relating to treatment control, QoL, physical function, global impression of change, sleep disturbance, and work presenteeism and performance.

There were no unexpected adverse events, but there was one death from subacute bacterial endocarditis in a participant in the BCT plus triamcinolone–lidocaine group that was deemed possibly related to the trial treatment.

Paskins et al conclude: “In community settings of musculoskeletal services, we have shown that an ultrasound guided intra-articular hip injection of corticosteroid and local anaesthetic, administered with advice and education, is a clinically effective treatment for rapid and sustained symptom response compared with advice and education alone for people with hip osteoarthritis.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

BMJ 2022; 377: e068446