Preoperative Intra-articular Steroid Injections as Predictors of Hip Arthroscopy: 2-Year Outcomes

Abstract

Background: In patients with femoroacetabular impingement, preoperative diagnostic injections are commonly used to establish a diagnosis of intra-articular pathology. In some cases, intra-articular steroid injections are also used for therapeutic purposes. Purpose/Hypothesis: The purpose of this study was to determine if a positive response to intra-articular steroid injection was predictive of superior outcomes after hip arthroscopy to determine if the response to intra-articular steroid injection was predictive of outcomes after hip arthroscopy. It was hypothesized that a positive response to a preoperative hip injection would be predictive of improved short- to midterm outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective study of 208 patients who elected to have ultrasound-guided intra-articular steroid injection before they underwent hip arthroscopy between January 2016 and December 2016. Patients were divided into 2 groups: those who showed improvement in pain after the injection (steroid responder group) and those who showed no response (nonresponder group). The authors compared the preoperative and 2-year postoperative patient-reported outcomes (modified Harris Hip Score [mHHS] and Hip Outcome Score–Activities of Daily Living [HOS-ADL]) and radiographic findings between groups. Clinical endpoints, including rates of revision and conversion to total hip arthroplasty, were also reviewed. Results: There were 88 patients in the nonresponder group and 120 patients in the responder group, with no significant between-group differences in preoperative descriptive variables. The responder group had significantly higher 2-year mHHS and HOS-ADL, pre- to postoperative change in mHHS and HOS-ADL, percentage of patients achieving the patient acceptable symptomatic state (PASS) on the mHHS, and percentage of patients reaching the minimum clinically important difference and the PASS on the HOS-ADL. There was no difference in Tönnis grade, acetabular labrum articular disruption grade, revision rate, or conversion to total hip arthroplasty between the 2 groups. Conclusion: The response to preoperative intra-articular injection did aid in predicting 2-year patient-reported outcomes of hip arthroscopy for femoroacetabular impingement. Overall, the result of a preoperative intra-articular injection can be a helpful clinical tool for surgical decision-making and counseling patients on expected outcomes after hip arthroscopy.

Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: An Updated Review

“…In a 2-year follow-up study, 208 patients underwent arthroscopic surgery for FAI syndrome after injection of betamethasone and lidocaine. 58) Those who responded to the injection had better 2-year clinical outcomes than those who did not respond to injections after arthroscopic surgery. This study highlighted the predictive value of the injection on subsequent arthroscopic surgery in FAI syndrome regardless of the efficacy in diagnosis or pain relief.…”

Treatment of Hip Cartilage Defects in Athletes

“…Relief of groin-based hip pain after a preoperative intra-articular steroid injection is shown to predict achievement of minimal clinically important difference and patient-acceptable symptom state 2 years after hip arthroscopy. 19 Pennock et al 20 evaluated the efficacy of steroid injection in athletic adolescents presenting with evidence of FAIS, showing that of the 22/93 included hips, who failed activity modification and progressed to corticosteroid injection, 50% avoided subsequent operative management within 1 year of the injection, whereas the other 50% converted to arthroscopy. This tool remains the first-line treatment modality alongside conservative measures of rest, activity modification, and physical therapy.…”

Two-Tiered Resection of Cam Lesions in Hip Femoroacetabular Impingement: Optimizing Femoral Head Sphericity

“…For patients with suspected symptomatic FAI, conservative treatment is attempted with physical therapy, nonsteroidal antiinflammatory drugs, and in some cases, corticosteroid injections. 18 If these measures fail, magnetic resonance imaging is obtained to assess the integrity of the labrum and status of the articular cartilage.…”