Background:

Intra-articular corticosteroid injections are commonly administered for hip pain. However, guidelines are conflicting on their efficacy, particularly in patients without arthritis. This study assessed for an association of corticosteroid injections and the incidence of total hip arthroplasty at 5 years.

Methods:

Patients with a diagnosis of hip pain without femoroacetabular osteoarthritis who were administered an intra-articular corticosteroid injection of the hip within a 2-year period were identified from the Mariner PearlDiver database. Patient were matched to patients with a diagnosis of hip pain who did not receive an injection. 5-year incidence of total hip arthroplasty was compared between matched patients who received an intra-articular corticosteroid injection and those who did not.

Results:

2,540,154 patients diagnosed with hip pain without femoroacetabular arthritis were identified. 25,073 (0.9%) patients received a corticosteroid injection and were matched to an equal number of control patients. The incidence of total hip arthroplasty (THA) at 5-year-follow up was significantly higher for the corticosteroid cohort compared to controls (1.1% vs. 0.5%; p < 0.001). The incidence and risk of THA increased along with number of injections (1 injection: 0.8%, OR 1.37; 95% CI, 1.34–1.42; p < 0.001, 2 injections: 1.1%; OR 1.45; CI, 1.40–1.50; p < 0.001, ⩾3 injections: 1.5%; OR 1.48; CI, 1.40–1.56; p < 0.001).

Conclusions:

There may be a dose-dependent association of corticosteroid injections and a greater risk of total hip arthroplasty at 5 years. These results along with the conflicting guidelines on the efficacy of intra-articular steroids for hip pain should prompt physicians to consider osteoarthritis progression that may occur in the setting of corticosteroid injections in non-arthritic hips.

中文翻译：

---

关节内皮质类固醇与 5 岁时全髋关节置换术风险增加相关

背景：

关节内注射皮质类固醇通常用于治疗髋部疼痛。然而，指南对其疗效存在争议，特别是对于没有关节炎的患者。本研究评估了 5 年时皮质类固醇注射与全髋关节置换术发生率之间的关系。

方法：

从 Mariner PearlDiver 数据库中筛选出诊断为髋关节疼痛但不伴有股骨髋臼骨关节炎且在 2 年内接受髋关节关节内皮质类固醇注射的患者。将患者与诊断为髋部疼痛但未接受注射的患者进行匹配。比较接受关节内皮质类固醇注射和未接受关节内皮质类固醇注射的匹配患者的 5 年全髋关节置换术发生率。

结果：

共确定了 2,540,154 名被诊断患有髋部疼痛但没有股骨髋臼关节炎的患者。25,073 名 (0.9%) 患者接受了皮质类固醇注射，并与同等数量的对照患者进行匹配。5 年随访时，皮质类固醇组的全髋关节置换术 (THA) 发生率显着高于对照组（1.1% vs. 0.5%；p  < 0.001）。THA 的发生率和风险随着注射次数的增加而增加（1 次注射：0.8%，OR 1.37；95% CI，1.34–1.42；p < 0.001，2 次注射：1.1%；OR  1.45；CI，1.40–1.50；p  < 0.001，⩾3 次注射：1.5%；OR 1.48；CI，1.40–1.56；p  < 0.001）。

结论：

皮质类固醇注射可能与 5 岁时进行全髋关节置换术的风险较高存在剂量依赖性相关性。这些结果以及关于关节内类固醇治疗髋部疼痛疗效的相互矛盾的指南应促使医生考虑在非关节炎髋部注射皮质类固醇时可能发生的骨关节炎进展。