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

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.

The efficacy of intra-articular HYADD4-G injection in the treatment of femoroacetabular impingement: results at one year follow up

“… 16 and Lee et al. 17 in showing that VS with HA is a safe and efficient treatment for this condition. As a future perspective, it would be interesting to compare the efficacy of classical HA with hexadecilamide derivate to investigate the possible advantages of its peculiar composition and structure.…”

“…Accordingly, Leite et al., after having conducted a systematic review and meta-analysis, do not recommend VS in hip OA given the scarce evidence of its efficacy against pain and disability up to 3 months and no difference at 6 months despite high evidence of safety compared to placebo 15 . On the other hand, evidence on the possible use of VS in FAI is still limited: to our knowledge, the use of HA in the treatment of FAI has been investigated only by two studies 16 , 17 , both using a high molecular weight HA, and the efficacy of an hexadecylamide derivate of HA in FAI has never been investigated yet.…”

Ultrasound-guided hydrodilatation for adhesive capsulitis of the hip is a safe and effective treatment

“…According to earlier reports, spontaneous resolution of symptoms is possible but unpredictable, requiring over 18 months in most cases [ 7 , 10 , 16 , 17 ]. IA injections with capsular distension are easily performed, and many reviews support hydrodilatation as a treatment modality to improve short-term pain and function [ 16 , 19 , 24 ]. Thus, it is a good nonsurgical option for patients with ongoing pain and disability and for whom complete spontaneous resolution cannot be guaranteed.…”

Refractory pain following hip arthroscopy: evaluation and management

“…If a patient does not improve, and is still believed to be intra-articular, the next step should include a corticosteroid injection with radiological confirmation of intra-articular presence. This stems from the randomized, double-blind, cross-over study by Lee and colleagues [ 11 ]. In this study of 30 patients with clinical and radiographic evidence of FAI undergoing hip injection with either corticosteroid or HA, greater, statistically significant, improvements in hip disability and numeric pain ratings were observed in patients who first underwent an HA injection, with a corticosteroid injection 2 weeks later if no response to the initial HA injection.…”