Intra-articular steroids for the treatment of coxarthrosis; a retrospective cohort study comparing three contrast techniques

Abstract

Introduction: Intra-articular steroid injections (IAS) are a treatment for coxarthrosis. This study examines the efficacy of three fluoroscopy-guided IAS contrast techniques for coxarthrosis: contrast-assisted (Iohexol), air arthrogram-assisted and blind (contrast/air free) and stratifies efficacy based on multiple patient variables.

Materials and methods: A cohort of 307 hip IAS was retrospectively analysed over a four-year period. The primary outcome was efficacy of IAS between each technique group, defined by duration of symptomatic relief. The secondary outcome was efficacy based on multiple patient variables. Variables included age, BMI, gender, type of osteoarthritis, grade of osteoarthritis, smoking status, co-morbidity index and duration of pre-injection symptoms. Chi-squared, Pearson, One Way ANOVA and F-tests were used for statistical analysis.

Results: Total failure (< 1 week symptomatic relief) was 20% (contrast 20%, air 14%, blind 26%). >3 months of symptomatic relief was experienced by 35%, with the air arthrogram technique containing the largest proportion of IAS achieving > 3months of relief within its own group (contrast 35%, air 38%, blind 28%). Non-smokers experienced a longer duration of symptomatic relief in the air arthrogram group (p = 0.04). Older patients had a longer duration of symptomatic relief with the blind technique (p = < 0.001). There were no significant differences between the three techniques based on the other patient variables.

Conclusion: Air arthrogram is an effective method of confirming injection placement in hip IAS for coxarthrosis and the use of a contrast agent (e.g., Iohexol) may not be required. Non-contrast techniques may produce longer duration of symptomatic relief in non-smokers and in older patients.

Keywords: Coxarthrosis; Hip; Injections; Osteoarthritis; Pain; Steroids.