J Korean Med Sci.  2016 Nov;31(11):1822-1827. 10.3346/jkms.2016.31.11.1822.

Intra-Articular Injections in Patients with Femoroacetabular Impingement: a Prospective, Randomized, Double-blind, Cross-over Study

• Lee YK
• Lee GY
• Lee JW
• Lee E
• Kang HS

• KMID: 2470281
• DOI: http://doi.org/10.3346/jkms.2016.31.11.1822

Abstract

We evaluated and compared the effectiveness of intra-articular injection of hip joint using hyaluronic acid and steroid in patients with femoroacetabular impingement (FAI). Thirty patients with FAI clinically and radiologically were enrolled and underwent hip injection using steroid (TA) or hyaluronic acid (HA) at 0-weeks with cross-over injection at 2-weeks in patients without clinical response of decrease of pain intensity less than 2-point. Patients were followed up to 12-weeks for pain intensity (Numeric rating scale, NRS: 0-10), hip disability score (HOOS), oral medication and adverse events. In 17 patients without cross-over, HOOS at 2-weeks was improved significantly in patients with HA injection (mean increase of HOOS = 13.8 with HA vs. -2.2 with TA, P = 0.031) without difference of NRS (P = 0.943). In 13 patients with cross-over, NRS was significantly improved at 2-weeks with first TA injection (mean decrease of NRS= 1.7 with first TA vs. 0.3 with first HA, P = 0.036), without difference of HOOS (P = 0.431). At 4-weeks, NRS and HOOS were significantly different according to injection drugs (NRS: 0.9 with TA first and HA later vs. 2.7 with HA first and TA later, P = 0.001; mean increase of HOOS: 5.3 with TA first and HA later vs. 10.2 with HA first and TA later, P = 0.032). Intra-articular hip injection may be effective in FAI, with faster effect of pain improvement by TA and more delayed effect of function improvement by HA.

Keyword

Femoroacetabular Impingement; Hip; Injections; Glucocorticoids; Hyaluronic Acid

MeSH Terms

Adult
Cross-Over Studies
Double-Blind Method
Female
Femoracetabular Impingement/*drug therapy
Flushing/etiology
Hip Joint/physiopathology
Humans
Hyaluronic Acid/*therapeutic use
Injections, Intra-Articular/adverse effects
Male
Middle Aged
Pain Measurement
Prospective Studies
Steroids/*therapeutic use
Time Factors
Treatment Outcome
Young Adult
Hyaluronic Acid
Steroids

Figure

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  Fig. 1 Intra-articular hip injection is done after targeting lateral side of femur-neck junction on supine position of patients fluoroscopically. After confirmation of intra-articular location of spinal needle using small amount of contrast, steroid or hyaluronic acid is injected slowly.

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  Fig. 2 Flow diagram shows the study flow from enrollment to follow-up during 4 weeks, as well as the number of clinical responders.

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