Hip Corticosteroid Injections on Trial?

With so many suffering around the world with hip pain, it is imperative that any solution be as safe as possible. Because some doubt has been expressed regarding hip corticosteroid injections as they may accelerate joint degeneration, a team from the Hawaii Permanente Medical Group and the University of Hawaii, both in Honolulu, decided to dig deeper into the topic of hip corticosteroid injections.

Their work, “Rapidly Destructive Hip Disease Following Intra-Articular Corticosteroid Injection of the Hip,” has been published in the September 22, 2021 edition of The Journal of Bone and Joint Surgery.

Co-author Kanu Okike M.D., M.P.H. of Hawaii Permanente Medical Group told OTW, “Recent case reports have suggested that hip corticosteroid injections could lead to rapidly destructive hip disease, but a formal analysis of this risk had not yet been done.”

A Two-Part Study

First, the research team looked at patients who developed rapidly destructive hip disease between 2013 and 2016 (which became the study group).  Then they looked for patients who’d received a total hip arthroplasty but for whom the diagnoses not rapidly destructive hip disease (these patients were the control arm of the study).

Second, doing a retrospective cohort analysis, the researchers assessed all patients who’d received a fluoroscopically guided intra-articular hip corticosteroid injection at the University of Hawaii from 2013 to 2016.

Yes, a Dose-Response Curve

“In our study, we found that hip corticosteroid injections were associated with an increased risk of rapidly destructive hip disease,” said Dr. Okike to OTW. “While the risk was low for patients who received a single low-dose injection, the risk was higher for patients who received high-dose injections or multiple injections.”

And since hip pain is not something that tends to retreat with one shot, Dr. Okike’s additional recommendation is more proof that better treatments are needed.

“Our study identifies risks which should be shared with patients in the informed consent process prior to hip corticosteroid injection,” said Dr. Okike to OTW. “In addition, caution should be taken with multiple injections as well as high-dose injections.”