SAN ANTONIO — Researchers found no significant pain reduction in most patients at 14 days after intra-articular injection of cortisone for femoroacetabular impingement and labral tears, according to a study presented at the Arthroscopic Association of North America Annual Meeting.
“Intra-articular cortisone injection has limited clinical benefit in 63% of the patients with symptomatic femoroacetabular impingement and labral tear,” Bruce A. Levy, MD, of Mayo Clinic, Rochester, Minn., said. “Our data showed absolutely no difference in pain relief between the different steroid preparations.”
Levy and the investigators noted there was lack of clinical evidence on the efficacy of cortisone injections in patients with femoroacetabular impingement (FAI) and labral tears. They retrospectively reviewed 35 patients with symptomatic FAI and labral tears confirmed on MRI who underwent fluoroscopic-guided intra-articular injections of cortisone with local anesthetic. All of the patients included in the study had a minimum of 50% pain relief during the phase when the local anesthetic was administered. The researchers excluded patients who had prior ipsilateral hip surgery. Patients had a mean age of 34 years, and study included 29 women and six men. Twenty percent of patients had Tonnis grade 0 osteoarthritis (OA) and 80% of patients had Tonnis grade 1 OA.
The investigators rated pain using the Numeric Rating Scale (NRS) and collected NRS scores prospectively at the following times: pre-injection; in the first 24 hours post-injection (the anesthetic phase); and 14 days post-injection. The patients were compared at each time period for three different steroid preparations: methylprednisolone in 21 patients; triamcinolone in 12 patients; and betamethasone in two patients.
“A two-point absolute change was considered the minimal amount of significant pain relief,” Levy said.
The mean pre-injection NRS score was seven points, the 24-hour score was one point and the 14-day score was four points. In all, 13 patients reported a change of greater than two points on the NRS pain scale at 14 days, while 63% of patients said they had less than two points on the NRS pain scale at 14 days. Of the 63% who had less than two points of pain relief, 21 patients showed no pain relief. The average pain relief after cortisone injection was 9.4 days.
“As a group, the Numeric Rating Scale scores significantly improved at immediate post-injection compared to baseline. However, pain relief significantly diminished from immediate to 14 days post-injection for each patient,” Levy said. “We found no significant difference in pain reduction between the different steroid preparations.”
The study was limited by its retrospective design, small cohort and lack of control group, according to Levy. “There were no previously published data that we are aware of assessing the therapy to benefit intra-articular hips in this setting,” he said. – by Renee Blisard Buddle
Levy B. Paper #SS-29. Presented at: Arthroscopy Association of North America Annual Meeting; April 25-27, 2013; San Antonio.
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Bruce A. Levy, MD, can be reached at Mayo Clinic, 200 First St., SW, Rochester, MN 55905.
Disclosure: Levy receives royalties from VOT Solutions and Arthrex and is on the speaker’s bureau for the Canadian Orthopaedic Association.