In this study, 21% of the people who had a steroid injection in their hips developed rapidly destructive osteoarthritis, and 91% of those had to have a total hip replacement. Whether this is causal or coincidental is not clear. They think that steroid injections could damage the hip joint cartilage. ~ Dr. Broussard
Association of rapidly destructive osteoarthritis of the hip with intra-articular steroid injections
Arthroplast Today. 2018 Jun; 4(2): 205–209.
Published online 2018 May 7. doi: 10.1016/j.artd.2017.12.002
PMCID: PMC5994787
PMID: 29896554
Shane R. Hess, DO
Abstract
Background
To assess the relationship between rapidly destructive osteoarthritis (RDOA) of the hip and intra-articular steroid injections.
Methods
Coding records from 2000 to 2013 were used to identify all subjects who had a fluoroscopy-guided intra-articular hip injection to treat pain associated with primary osteoarthritis. Radiographic measurements from preinjection and postinjection imaging were evaluated with Luquesne’s classification of RDOA to determine diagnosis (greater than 50% joint space narrowing or greater than 2 mm of cartilage loss in 1 year with no other forms of destructive arthropathy). Demographic information, health characteristics, and number of injections were collected and analyzed as other potential explanatory variables. Patient outcome assessed by need for total hip arthroplasty (THA) after injection was also recorded.
Results
One hundred twenty-nine injection events met the inclusion criteria in a total of 109 patients. From this sample, 23 cases of RDOA were confirmed representing a 21% incidence of RDOA. Twenty-one of the patients (91%) with RDOA had a THA at a median time of 10.2 months (interquartile range: 6.5-11.2) compared with 27 (31%) of those without RDOA at a median time of 24.9 months (interquartile range: 15.3-65.3). Older patients, patients with more severe osteoarthritis, and patients who identified themselves as white were more likely to have a diagnosis of RDOA (P = .008; P = .040; P = .009, respectively).
Conclusions
The potential for RDOA and faster progression to THA raises questions about the use of intra-articular steroid injections for hip osteoarthritis and should be discussed with patients. Additional studies are needed to define a true relationship.