Hip Dysplasia by Paul E. Beaulé

Author:Paul E. Beaulé
Language: eng
Format: epub
ISBN: 9783030333584
Publisher: Springer International Publishing

Intra-Articular Hip Injections

Intra-articular hip injections using local anesthetic and corticosteroids have been a useful diagnostic tool for hip pain in a young adult [101–104]. Byrd and Jones in their study [104] demonstrated that response to intra-articular injection was a reliable indicator of intra-articular pathology in 90% of the patients. Although there is not enough literature on the efficacy of therapeutic intra-articular injections in the subset of patients with non-arthritic hip pain [1, 101, 105, 106], this could be a reasonable option in young adults with pre-arthritic hip pain and underlying dysplasia.

To our knowledge, there have been no studies on the results of intra-articular injections in dysplastic hips. Tangtiphaiboontan et al. [101] studied the therapeutic efficacy of intra-articular corticosteroid injections for adolescents with hip pain. Although intra-articular corticosteroid injections were not as effective for patients with hip pain in the presence of osseous deformities like FAI, they provided prolonged symptom relief in patients without osseous deformities, even in the presence of a labral tear on MRI. This was also seen in the study by Hunt et al. [1], as a single therapeutic injection of 40 mg of triamcinolone with 1% lignocaine produced symptomatic relief in all six patients undergoing the injection to 1 year follow up. All six of these patients had a labral tear as confirmed by magnetic resonance arthrography. Thus, patients with isolated labral tears without static FAI, such as patients with hip dysplasia, can potentially benefit from intra-articular corticosteroid injections. However, results of the same in patients with FAI have not been consistent [106] and as such, there is no evidence to warrant routine use of therapeutic corticosteroid injections in labral tears [107].

Other authors have studied the effects of intra-articular hyaluronic acid (HA) and platelet-rich plasma (PRP) injections in young adults with hip pathology [102, 105, 108, 109]. There are studies [110] that show that hyaluronic acid triggers various intracellular signals like cytokine release and stimulation of cell cycle proteins by binding to receptors like cluster determinant 44 (CD44), intracellular adhesion molecule -1 (ICAM-1), and receptor for hyaluronate-mediated motility (RHAMM). Also, different molecular weights of HA have different effects on specific receptors; and it has been shown that high molecular weight HA (1500–2000 kDa) has better outcomes than low molecular weight HA for hip joint treatment [111–113]. Abate et al. showed significant pain reduction and functional improvement in mild FAI treated with intra-articular HA. Lee et al. [108], in their prospective double-blind cross-over study, showed higher long-term efficacy of intra-articular HA in comparison to intra-articular corticosteroid. Khan et al. [102], in their systematic review, also demonstrated clinically significant and sustained improvement with intra-articular HA in their pooled group of young adult patients.

Recent studies from the osteoarthritis literature seem to suggest the efficacy of PRP in osteoarthritis and have also compared these to HA [114–119]. Randomized control trials by Cole et al. [114] and Raeissadat et al. [115] showed higher efficacy and superior outcomes with PRP in comparison to HA in patients with knee osteoarthritis at 12 months follow up, although this was not found to be the case in a meta-analysis by Zhang et al.

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