Steroid injections provide effective pain relief and enable improved movement for up to four months for adults with hip osteoarthritis, researchers report today.
A study led by researchers at Keele University’s School of Medicine, UK, say their findings, published in The BMJ, “provide evidence to inform international guidelines and offer important choice to patients, who often believe their treatment options are limited”.
UK guidelines advise combining non-drug and drug treatments for hip osteoarthritis. While some trials have found clinical benefit eight weeks after steroid injection in patients with hip osteoarthritis, there are conflicting results, the researchers say.
Zoe Paskins and colleagues compared the clinical effectiveness of adding a single ultrasound guided intra-articular hip injection of corticosteroid and local anaesthetic to advice and education in adults with hip osteoarthritis.
The trial involved 199 adults, whose average age was 63 years and 57% of whom were women. All had hip osteoarthritis and had reported at least moderate pain at two NHS community musculoskeletal centres in England.
Out of this cohort, 67 were randomly assigned to receive advice and education, (best current treatment or BCT), 66 to BCT plus ultrasound guided injection of the steroid triamcinolone with lidocaine, and 66 to BCT plus ultrasound guided injection of lidocaine only.
The primary outcome measure was intensity of hip pain on a scale of 0-10, reported by patients at two weeks and at two, four, and six months. Secondary outcomes included physical function and pain self-efficacy.
Over six months, individuals in the BCT plus ultrasound-triamcinolone-lidocaine group reported a greater reduction in pain intensity – by an average score of 1.4 and 0.5 on the pain scale – compared to those receiving BCT alone and BCT plus ultrasound-lidocaine, respectively.
More significant differences were seen at two weeks and two months than between four and six months), while no significant differences in pain or function were reported at six months.
Participants in the BCT plus ultrasound-triamcinolone-lidocaine group were more likely to score less than five on the pain scale at two weeks and at two and four months than were those in the BCT group.
This group also reported more improvements in physical function and pain self-efficacy to four months compared with those who received just BCT.
At six months, this group was more likely to be satisfied with care and treatment received than those receiving BCT at 58.2% compared to 34% and were more likely to say they were not limited in their usual activities because of hip pain (66.7% v 44.6%).
Seven serious adverse events were recorded, one of which was a bacterial infection. Researchers said this was possibly related to trial treatment.
While the research team says there were some trial limitations, including a lack of blinding between the BCT versus BCT plus ultrasound-triamcinolone-lidocaine groups and relying on self-reporting by patients, strengths included the large sample size, the inclusion of two comparison arms, the length of follow-up, and the high response rates.
“In patients with mild to moderate hip osteoarthritis, ultrasound guided corticosteroid and local anaesthetic injection with advice and education led to greater pain reduction and improvement in function over six months, compared with advice and education alone,” they write.
“These findings provide evidence to inform international guidelines and offer important choice to patients, who often believe their treatment options are limited.”
Paskins Z, Bromley K, Lewis M et al. Clinical effectiveness of one ultrasound guided intra-articular corticosteroid and local anaesthetic injection in addition to advice and education for hip osteoarthritis (HIT trial): single blind, parallel group, three arm, randomised controlled trial. BMJ 7 April 2022; doi: 10.1136/bmj-2021-068446
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