Extended reports
Radiographic patterns and response to corticosteroid hip
injection
a Department of Rheumatology, Wrexham Maelor
Hospital, Wrexham , b Department of
Rheumatology, Nevill Hall Hospital, Abergavenny , c Staffordshire Rheumatology Centre, Haywood Hospital,
Stoke on Trent , d Department of Radiology, North Staffordshire
Hospital Trust, Stoke on Trent
Correspondence to: Dr M J Plant, Department of Rheumatology, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, Clwyd LL13 7TD.
Accepted for publication 6 June
1997
OBJECTIVES
A prospective, open study of
corticosteroid hip injection (CHI) was performed to determine if
different radiological patterns of arthritis vary in their response.
METHODSForty five patients (15 with rheumatoid
arthritis, 27 with osteoarthritis, and three with anklyosing
spondylitis) underwent hip injection with 80 mg
methyl- prednisolone and lignocaine under x ray
control. Outcome was assessed at two, 12, and 26 weeks for pain, range
of hip movement, and graded functional questionnaire. Patients
estimated their pain in four components, night pain, rest pain, weight
bearing, and referred pain, each measured by 10 cm visual analogue
score and summed to give a total score out of 40 cm. Hip radiographs
were evaluated blindly for pattern and severity of arthritis, as well
as for progression between 0 and 26 weeks.
RESULTSMedian total pain score decreased from
29 cm at baseline to 22 cm at two weeks (p=0.0001), 24 cm at 12 weeks
(p=0.03), but had returned nearly to baseline by 26 weeks (25 cm,
p=0.3). Greatest improvement was seen for night pain. Mean range of
internal rotation increased from 16 to 28 degrees at two weeks (p=0.03)
and 23 degrees at 12 weeks (p=0.06). Functional ability did not change.
Hips with an atrophic pattern of arthritis on plain radiography gained negligible pain relief at two weeks compared with hips with a hypertrophic or mixed bone response (p=0.04). The degree of pain relief
was similar in patients with OA and RA, and was not influenced by
radiographic severity or by the direction of migration of the femoral head.
CONCLUSIONPain and internal rotation improve
for up to 12 weeks after CHI. CHI offers a useful and safe therapeutic
option for patients with hip arthritis, with the exception of those
with a purely atrophic radiological pattern.
© 1997 by Annals of the Rheumatic Diseases
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