| Among the many treatment options available for | | | | Universities OA Index (WOMAC) pain scores fell by |
| people with osteoarthritis are injections of | | | | 49.2% in the active treatment group and by 2.5% in |
| glucocorticoids… commonly known as cortisone | | | | the placebo group. The WOMAC is considered the |
| injections. | | | | cornerstone of patient response in osteoarthritis clinical |
| Glucocorticoids, also called corticosteroids or steroids, | | | | trials so that this response was critical to determining |
| are anti-inflammatory compounds that are synthetic | | | | the effectiveness of the therapies. |
| copies of what the body’s adrenal glands | | | | In addition, 67.7% of the corticosteroid group showed a |
| make. When properly injected, these corticosteroids | | | | 20% WOMAC improvement, compared to 23.8% of |
| reduce the swelling, redness, heat, and pain that | | | | the placebo group. Findings were similar for a 50% |
| commonly accompany arthritis. | | | | WOMAC improvement (61.3% versus 14.3%). |
| Traditionally, the use of glucocorticoid injections for the | | | | These differences were maintained at 3 months. |
| hip have been perceived to not work well… or | | | | The trial confirmed that when the steroid is injected |
| at least not work as well as they do for the knee. | | | | under image guidance and can be certain that the |
| However, the hip joint is one of the most difficult joints | | | | steroid is in the right place, the steroids work very well |
| in the body to inject accurately. | | | | for most patients with moderately advanced or |
| A new study reported in Arthritis and Rheumatism | | | | severe hip OA. |
| (Lambert RGW, Hutchings EJ, Grace MGA, Jhangri | | | | A potentially even more useful technique for |
| GS, Conner-Spady B, Maksymowych WP. Steroid | | | | localization of the hip joint is ultrasound (US). US has |
| injection for osteoarthritis of the hip: A randomized, | | | | the advantages of being fast, of showing soft tissue |
| Double-blind, Placebo-controlled Trial. Arthritis Rheum. | | | | as well as bone, and of having no radiation associated |
| 2007;56:2278-2287) has demonstrated that correctly | | | | with it. Fluoroscopy has comparatively much radiation |
| placed steroid injections can produce considerable | | | | exposure both to the patient as well as to the |
| improvement in patients with osteoarthritis (OA) of the | | | | physician doing the injection. |
| hip. | | | | In our clinic we use US as opposed to fluoroscopy. In |
| What the researchers wanted to answer was | | | | any event, though, one or the other should be used to |
| whether the steroid was less effective because of | | | | ensure proper placement of the needle. |
| the way it was injected. They wanted to ensure entry | | | | Cortisone injection into the hip is also a procedure that |
| of the therapeutic agent into the synovial space. As a | | | | should be done using sterile techniques. |
| result they used fluoroscopic guidance. Fluoroscopy is | | | | In patients who respond to corticosteroid injections, |
| a type of real time x-ray. | | | | these can be repeated as often as three times per |
| The investigators studied 52 symptomatic patients with | | | | year. Another therapeutic option is injection of |
| hip OA who were randomized in a double-blind fashion | | | | viscosupplements into the hip. These are gel-like |
| to fluoroscopically guided intra-articular injection of | | | | lubricants that also help reduce pain and allow the joint |
| bupivacaine (an anesthetic agent) and 40 mg | | | | to glide better. Examples of these are compounds |
| triamcinolone (a type of long-acting glucocorticoid) or to | | | | such as Supartz, Hyalgan, and Synvisc. In patients who |
| bupivacaine and saline. | | | | are not considered surgical candidates or who do not |
| At 2 months, Western Ontario and McMaster | | | | want surgery, this is a viable option to consider. |