Hip steroid injections associated with bone changes

November 29, 2017, Radiological Society of North America
A 58-year-old woman with left hip pain. X-ray from one month prior to the steroid/anesthetic injection demonstrates moderate joint space narrowing (arrows) and bony proliferation (arrowheads). Credit: Radiological Society of North America

Osteoarthritis patients who received a steroid injection in the hip had a significantly greater incidence of bone death and collapse compared with control groups, according to new research presented today at the annual meeting of the Radiological Society of North America (RSNA).

Receiving an of a steroid and anesthetic is a common treatment for patients who are experiencing pain and inflammation in a joint, such as the hip, knee or shoulder.

"Changes due to osteoarthritis, such as narrowing in the space between joints and the development of bony proliferations, typically develop slowly over time," said Connie Y. Chang, M.D., radiologist at Massachusetts General Hospital and assistant professor of radiology at Harvard Medical School in Boston. "When reading follow-up radiographs of patients who had received a hip injection, we noticed changes had developed rapidly in some patients."

To determine whether arthritis worsened in patients following a hip steroid/anesthetic injection, Chang and a team of radiologists specializing in musculoskeletal diagnostic imaging and intervention, including hip injections, conducted a study involving 102 patients (age range 19-92, including 62 women) who received X-ray images of the treated hip at the time of the injection and during a follow-up three to nine months later.

X-rays three months after the steroid/anesthetic injection demonstrate complete loss of joint space (arrows), sclerosis of the femoral head (*), and flattening of femoral head articular surface consistent with collapse (arrowheads). Credit: Radiological Society of North America

Two musculoskeletal radiologists independently reviewed the X-ray images of the patients who received the injections and those of two control groups matched to demographics and follow-up imaging duration. The control groups consisted of 102 patients who had hip X-rays without steroid/anesthetic injection and 44 patients who underwent imaging and a steroid/anesthetic injection in the shoulder.

The radiologists reported new osteonecrosis in 22-24 percent of hip injection patients, compared to 5-9 percent in the hip control group and 5 percent in the shoulder injection control group. They observed bone collapse in the head of the femur bone, located at the top of the femur at the articulation with the pelvic bone, in 15-17 percent of hip injection patients, versus 4 percent of hip control patients and 2 percent of shoulder control patients.

Hip injection patients also showed increased imaging findings of osteoarthritis compared to the control groups, but the differences were not statistically significant.

Dr. Chang noted that patients receiving hip injections have symptoms of hip pain severe enough to require the injection and may be prone to faster progression of bony changes compared to the groups. These considerations may be important as some orthopedists are requesting higher steroid doses and injections in younger patients.

"We need to look at what's going on with the steroid/anesthetic injectate and osteoarthritis patients to determine what's causing the changes that occur in some patients," Dr. Chang said. "However, we don't want to deter from getting an injection. These results are enough to warrant an investigation, but not enough to cancel a procedure."

Explore further: Noninvasive procedure is superior to steroid injection for painful knee osteoarthritis

Related Stories

Noninvasive procedure is superior to steroid injection for painful knee osteoarthritis

November 2, 2017
For patients with osteoarthritis of the knee, a minimally invasive procedure called cooled radiofrequency ablation (CRFA) provides better pain reduction and functional improvement compared to steroid injection of the knee, ...

Steroid injection betters hand function with carpal tunnel

September 21, 2017
(HealthDay)—Local steroid injection is effective for treatment of carpal tunnel syndrome (CTS) and improves hand function, according to a small study published online Sept. 13 in the International Journal of Rheumatic Diseases.

Findings do not support steroid injections for knee osteoarthritis

May 16, 2017
Among patients with knee osteoarthritis, an injection of a corticosteroid every three months over two years resulted in significantly greater cartilage volume loss and no significant difference in knee pain compared to patients ...

Sonography may aid hyaluronic acid injections for knee arthritis

August 14, 2017
(HealthDay)—Sonography-guided hyaluronic acid injection may yield better results than surface anatomy-guided injection in patients with knee osteoarthritis, according to a study published online Aug. 9 in the International ...

Steroid injection linked to increased risk of bone fractures

October 25, 2012
Patients treated with an epidural steroid injection for back pain relief are at increased risk of bone fractures in the spine, according to a Henry Ford Hospital study.

Weighing nonsurgical treatment options for knee osteoarthritis pain

September 19, 2017
Osteoarthritis (OA) is a progressive "wear and tear" disease of the joint. Osteoarthritis of the knee (knee OA) may not be totally preventable but according to Elizabeth Matzkin, MD, an orthopaedic surgeon specializing in ...

Recommended for you

Research shows diet has little influence on precursor to gout

October 11, 2018
Dietary factors have a far smaller influence on urate levels (a precursor to gout) than previously envisaged, new University of Otago research reveals.

More doctor visits lead to less suicide attempts for fibromyalgia patients

September 19, 2018
Fibromyalgia patients who regularly visit their physicians are much less likely to attempt suicide than those who do not, according to a new Vanderbilt University Medical Center study published in Arthritis Care & Research.

Antioxidant found to be effective in treating mice with osteoarthritis

September 14, 2018
A team of researchers in Belgium and the Netherlands has found that feeding a common antioxidant to test mice was effective in treating osteoarthritis. In their paper published in Science Translational Medicine, the group ...

Researchers find answers as to why some people are at risk of gout

September 12, 2018
University of Otago researchers have helped characterise a genetic variant that enables new understanding of why some people are at risk of gout, a painful and debilitating arthritic disease.

Emotions like anger and sadness may cause pain as well as being a result of it

September 10, 2018
While emotions such as anger or sadness are often thought of as being a result of stress or pain, findings recently published by Penn State researchers suggest that negative or mixed emotions could function as stressors themselves.

Dietary carbohydrates could lead to osteoarthritis, new study finds

August 9, 2018
Do your knees ache? According to new findings from the Oklahoma Medical Research Foundation, your diet could be a culprit.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.