Background Intraarticular (ia) corticosteroids (CS) are demonstrated to be an effective treatment in hip osteoarthritis (OA) patients refractory to conventional oral analgetic therapy. However, their efficacy in different radiological stages and in different types of bone response of the disease is not well defined.
Objectives To evaluate the therapeutic effect of ia CS in patients with hip OA from different radiological grade and with different bone response.
Methods 90 patients with hip OA were included in the study (15 from 4th radiological grade of Kellgren-Lawrence scale, 30 – from 3rd and 45 – from 2nd grade respectively). Additional distribution of the patients was performed according to the type of bone response as follows - atrophic, intermediate and hypertrophic type (30 patients in each group). In 15 patients a presence of synovitis was registered. 1 ia application of 40 mg methylprednisolone under fluoroscopic guidance was performed in all patients. In 90 age- and sex-matched control subjects with hip OA, who did not differ significantly from the CS-treated patient population in their radiological grade of the disease, an ia administration of local anaestetic (lidocaine) was performed also under fluoroscopic guidance. Evaluation of pain at rest and on motion (visual analogue scale, VAS 100mm), Lequesne and WOMAC index and range of motion of the injected hip joint (internal rotation) were assessed weekly in the first 3 months and monthly until the 6th month.
Results A significant decrease of most of the outcome measures, e. g. VAS pain at rest and on motion, Lequesne and WOMAC index, was registered in CS-treated patients from all radiological grades 24-48 hours after the local injection (p<0.05). A significant increase in the internal rotation of the injected hip joint was also found at this period, but only in patients from 2nd and 3rd Kellgren-Lawrence grade. The duration of the therapeutic effect of ia CS continues longer for all radiological grades as compared with those of local anaesthetic (p<0.05). In addition, it lasts significantly longer in patients from 2nd radiolocal grade in comparison with more severy affected cases from 3rd and 4th grade (p<0.05). A significant difference in the assessed outcome measures after local administration of ia CS was observed between patients with and without synovitis with more pronounced effect in cases with synovial inflammation (p<0.05). Significantly better efficacy of ia CS for all of the assessed parameters was also found in patients with hypertrophic and intermediate bone response as compared with the atrophic variant of hip OA (p<0.05).
Conclusions In conclusion, the therapeutic effect of ia CS is early – in the first 24-48 hours and continues significantly longer as compared with local anaesthetics. Its duration is longer in patients from 2nd radiological grade as compared with more advanced stages. The potency of the therapeutic effect depends on the type of the radiological changes as well as on the presence of synovitis. Predictors for good therapeutic response are the hypertrophic and intermediate bone response, and presence of synovitis, while the atrophic type bone remodeling and the advanced structural changes ≥ III Kellgren-Lawrence grade predict poor response to treatment with ia CS.
Disclosure of Interest None declared