Intra-articular hip injection: does pain relief correlate with radiographic severity of osteoarthritis?

Objective Intra-articular injection is being used widely for both diagnostic and therapeutic purposes in the hip. However, its efficacy is not always predictable in patients with hip osteoarthritis (OA). The purpose of this study was to determine whether the degree of radiographic severity of OA was...

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Veröffentlicht in:Skeletal radiology 2011-11, Vol.40 (11), p.1449-1454
Hauptverfasser: Deshmukh, Ajit J., Panagopoulos, Georgia, Alizadeh, Ahmadreza, Rodriguez, Jose A., Klein, Devon A.
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container_end_page 1454
container_issue 11
container_start_page 1449
container_title Skeletal radiology
container_volume 40
creator Deshmukh, Ajit J.
Panagopoulos, Georgia
Alizadeh, Ahmadreza
Rodriguez, Jose A.
Klein, Devon A.
description Objective Intra-articular injection is being used widely for both diagnostic and therapeutic purposes in the hip. However, its efficacy is not always predictable in patients with hip osteoarthritis (OA). The purpose of this study was to determine whether the degree of radiographic severity of OA was predictive of the response to intra-articular injection of local anesthetic with corticosteroid and to determine the relationship between immediate pain relief resulting from the anesthetic and delayed pain relief resulting from corticosteroid administration. Materials and methods This retrospective study included 217 patients (220 injections) with diagnosis of hip OA who underwent a fluoroscopically guided therapeutic hip injection of local anesthetic and corticosteroid. Hip radiographs were scored using the Kellgren–Lawrence scale. Immediate and delayed pain relief was documented using a visual analog scale. Logistic regression analysis was performed to investigate whether age, gender or radiographic severity of OA were independent predictors of pain relief. Degree of agreement between immediate and delayed response was assessed with the kappa coefficient. Results Immediate pain relief was reported in 68.2% of hips and delayed relief in 71.4% of hips. A high level of agreement was observed between immediate and delayed pain relief (kappa = 0.80, p  
doi_str_mv 10.1007/s00256-011-1120-8
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However, its efficacy is not always predictable in patients with hip osteoarthritis (OA). The purpose of this study was to determine whether the degree of radiographic severity of OA was predictive of the response to intra-articular injection of local anesthetic with corticosteroid and to determine the relationship between immediate pain relief resulting from the anesthetic and delayed pain relief resulting from corticosteroid administration. Materials and methods This retrospective study included 217 patients (220 injections) with diagnosis of hip OA who underwent a fluoroscopically guided therapeutic hip injection of local anesthetic and corticosteroid. Hip radiographs were scored using the Kellgren–Lawrence scale. Immediate and delayed pain relief was documented using a visual analog scale. Logistic regression analysis was performed to investigate whether age, gender or radiographic severity of OA were independent predictors of pain relief. Degree of agreement between immediate and delayed response was assessed with the kappa coefficient. Results Immediate pain relief was reported in 68.2% of hips and delayed relief in 71.4% of hips. A high level of agreement was observed between immediate and delayed pain relief (kappa = 0.80, p  &lt; 0.001). 94% of patients reporting immediate relief also reported relief 2 weeks later. Univariate and multivariate analysis revealed that neither gender nor age was related to immediate or delayed pain relief. Only severity of OA (based on radiographic analysis) was observed to be predictive of pain relief. Conclusion Pain relief following intra-articular hip injection correlated with radiographic severity of OA. This intervention may be of therapeutic and prognostic value in patients awaiting hip arthroplasty.</description><identifier>ISSN: 0364-2348</identifier><identifier>EISSN: 1432-2161</identifier><identifier>DOI: 10.1007/s00256-011-1120-8</identifier><identifier>PMID: 21331511</identifier><identifier>CODEN: SKRADI</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Age ; Analysis ; Anesthetics ; Anti-Inflammatory Agents - administration &amp; dosage ; Antiarthritic agents ; Arthroplasty (hip) ; Biological and medical sciences ; Bupivacaine - administration &amp; dosage ; Care and treatment ; Corticoids ; Corticosteroids ; Delayed response ; Diseases of the osteoarticular system ; Female ; Fluoroscopy ; Health aspects ; Hip ; Hip Joint - diagnostic imaging ; Humans ; Imaging ; Injections, Intra-Articular ; Investigative techniques, diagnostic techniques (general aspects) ; Local anesthetics ; Male ; Medical research ; Medical sciences ; Medicine &amp; Public Health ; Medicine, Experimental ; Methylprednisolone - administration &amp; dosage ; Methylprednisolone - analogs &amp; derivatives ; Middle Aged ; Miscellaneous. Osteoarticular involvement in other diseases ; Multivariate analysis ; Nuclear Medicine ; Orthopedics ; Osteoarthritis ; Osteoarthritis, Hip - diagnostic imaging ; Osteoarthritis, Hip - drug therapy ; Osteoarticular system. Muscles ; Pain ; Pain Measurement ; Pathology ; Radiodiagnosis. Nmr imagery. 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However, its efficacy is not always predictable in patients with hip osteoarthritis (OA). The purpose of this study was to determine whether the degree of radiographic severity of OA was predictive of the response to intra-articular injection of local anesthetic with corticosteroid and to determine the relationship between immediate pain relief resulting from the anesthetic and delayed pain relief resulting from corticosteroid administration. Materials and methods This retrospective study included 217 patients (220 injections) with diagnosis of hip OA who underwent a fluoroscopically guided therapeutic hip injection of local anesthetic and corticosteroid. Hip radiographs were scored using the Kellgren–Lawrence scale. Immediate and delayed pain relief was documented using a visual analog scale. Logistic regression analysis was performed to investigate whether age, gender or radiographic severity of OA were independent predictors of pain relief. Degree of agreement between immediate and delayed response was assessed with the kappa coefficient. Results Immediate pain relief was reported in 68.2% of hips and delayed relief in 71.4% of hips. A high level of agreement was observed between immediate and delayed pain relief (kappa = 0.80, p  &lt; 0.001). 94% of patients reporting immediate relief also reported relief 2 weeks later. Univariate and multivariate analysis revealed that neither gender nor age was related to immediate or delayed pain relief. Only severity of OA (based on radiographic analysis) was observed to be predictive of pain relief. Conclusion Pain relief following intra-articular hip injection correlated with radiographic severity of OA. This intervention may be of therapeutic and prognostic value in patients awaiting hip arthroplasty.</description><subject>Age</subject><subject>Analysis</subject><subject>Anesthetics</subject><subject>Anti-Inflammatory Agents - administration &amp; dosage</subject><subject>Antiarthritic agents</subject><subject>Arthroplasty (hip)</subject><subject>Biological and medical sciences</subject><subject>Bupivacaine - administration &amp; dosage</subject><subject>Care and treatment</subject><subject>Corticoids</subject><subject>Corticosteroids</subject><subject>Delayed response</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>Fluoroscopy</subject><subject>Health aspects</subject><subject>Hip</subject><subject>Hip Joint - diagnostic imaging</subject><subject>Humans</subject><subject>Imaging</subject><subject>Injections, Intra-Articular</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Local anesthetics</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Medicine &amp; Public Health</subject><subject>Medicine, Experimental</subject><subject>Methylprednisolone - administration &amp; dosage</subject><subject>Methylprednisolone - analogs &amp; derivatives</subject><subject>Middle Aged</subject><subject>Miscellaneous. Osteoarticular involvement in other diseases</subject><subject>Multivariate analysis</subject><subject>Nuclear Medicine</subject><subject>Orthopedics</subject><subject>Osteoarthritis</subject><subject>Osteoarthritis, Hip - diagnostic imaging</subject><subject>Osteoarthritis, Hip - drug therapy</subject><subject>Osteoarticular system. Muscles</subject><subject>Pain</subject><subject>Pain Measurement</subject><subject>Pathology</subject><subject>Radiodiagnosis. Nmr imagery. 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Osteoarticular involvement in other diseases</topic><topic>Multivariate analysis</topic><topic>Nuclear Medicine</topic><topic>Orthopedics</topic><topic>Osteoarthritis</topic><topic>Osteoarthritis, Hip - diagnostic imaging</topic><topic>Osteoarthritis, Hip - drug therapy</topic><topic>Osteoarticular system. Muscles</topic><topic>Pain</topic><topic>Pain Measurement</topic><topic>Pathology</topic><topic>Radiodiagnosis. Nmr imagery. 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However, its efficacy is not always predictable in patients with hip osteoarthritis (OA). The purpose of this study was to determine whether the degree of radiographic severity of OA was predictive of the response to intra-articular injection of local anesthetic with corticosteroid and to determine the relationship between immediate pain relief resulting from the anesthetic and delayed pain relief resulting from corticosteroid administration. Materials and methods This retrospective study included 217 patients (220 injections) with diagnosis of hip OA who underwent a fluoroscopically guided therapeutic hip injection of local anesthetic and corticosteroid. Hip radiographs were scored using the Kellgren–Lawrence scale. Immediate and delayed pain relief was documented using a visual analog scale. Logistic regression analysis was performed to investigate whether age, gender or radiographic severity of OA were independent predictors of pain relief. Degree of agreement between immediate and delayed response was assessed with the kappa coefficient. Results Immediate pain relief was reported in 68.2% of hips and delayed relief in 71.4% of hips. A high level of agreement was observed between immediate and delayed pain relief (kappa = 0.80, p  &lt; 0.001). 94% of patients reporting immediate relief also reported relief 2 weeks later. Univariate and multivariate analysis revealed that neither gender nor age was related to immediate or delayed pain relief. Only severity of OA (based on radiographic analysis) was observed to be predictive of pain relief. Conclusion Pain relief following intra-articular hip injection correlated with radiographic severity of OA. This intervention may be of therapeutic and prognostic value in patients awaiting hip arthroplasty.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>21331511</pmid><doi>10.1007/s00256-011-1120-8</doi><tpages>6</tpages></addata></record>
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source MEDLINE; SpringerLink Journals - AutoHoldings
subjects Age
Analysis
Anesthetics
Anti-Inflammatory Agents - administration & dosage
Antiarthritic agents
Arthroplasty (hip)
Biological and medical sciences
Bupivacaine - administration & dosage
Care and treatment
Corticoids
Corticosteroids
Delayed response
Diseases of the osteoarticular system
Female
Fluoroscopy
Health aspects
Hip
Hip Joint - diagnostic imaging
Humans
Imaging
Injections, Intra-Articular
Investigative techniques, diagnostic techniques (general aspects)
Local anesthetics
Male
Medical research
Medical sciences
Medicine & Public Health
Medicine, Experimental
Methylprednisolone - administration & dosage
Methylprednisolone - analogs & derivatives
Middle Aged
Miscellaneous. Osteoarticular involvement in other diseases
Multivariate analysis
Nuclear Medicine
Orthopedics
Osteoarthritis
Osteoarthritis, Hip - diagnostic imaging
Osteoarthritis, Hip - drug therapy
Osteoarticular system. Muscles
Pain
Pain Measurement
Pathology
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Radiography
Radiography, Interventional
Radiology
Regression analysis
Scientific Article
Therapeutic applications
title Intra-articular hip injection: does pain relief correlate with radiographic severity of osteoarthritis?
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