Good afternoon. This talk is on the safety of intra-articular hip corticosteroid injections. My name is Michael Kucharik, and I'm presenting on behalf of the Dr. Scott Martin Research. Our research team does not have any financial disclosures. We have received research support from the Conine Family Fund for joint preservation. Intra-articular corticosteroid injections are one of the mainstay treatments of osteoarthritis of the hip. Multiple randomized controlled trials have demonstrated that corticosteroid injections provide patients with significant pain and functional improvements when compared to a placebo treatment. However, there remains a fear regarding the safety of corticosteroid injections, as some in vivo studies have shown corticosteroids to be chondrotoxic. Two recent studies in the radiology literature attempted to address this concern by evaluating the safety of corticosteroid injections. As you can see on the screen, these studies reported very high rates of AVN and OA progression, which is concerning for clinicians who use corticosteroid injections as part of their everyday practice. However, these studies had two notable limitations, including the failure to compare against a control group matched for baseline osteoarthritis, and the failure to exclude patients with pre-injection avascular necrosis or subchondral insufficiency fracture. Thus, by addressing these limitations in our study, we aim to more accurately assess the safety of corticosteroid injections of the hip. The timeline of this study was between May 2007 and December 2019. The inclusion criteria for the injection cohort was they had to have had an MRI within 12 months prior to the corticosteroid injection. They also had to have radiographs before the injection, as well as after the injection within a 12-month window on both ends. And then the matched group, which was a control group, obviously did not undergo a corticosteroid injection. They would have undergone an MRI at our institution and had to have had radiographs before, within 12 months prior to the MRI, as well as within 12 months after the MRI. And notably, these two groups were propensity matched for age, sex, BMI, and OA severity. The radiographs before and after injection were reviewed by two musculoskeletal radiologists. We also had a third reader for discrepant reads, and they were blinded by group as well as time point. For the severity of osteoarthritis, we used a modified Kellgren-Lawrence grade. As you can see there, grade 1, 2, and 3. And that grading system was consistent with the two papers that were published in the radiology literature that reported those high rates of AVN and OA progression. And then we used binary variables for radiographic AVN as well as subchondral insufficiency fracture, and then used a four-tier system for femoral head collapse. And as you can see here, we have two examples, one going from A to B, showing a patient who had new left femoral head remodeling secondary to osteoarthritis. This patient had the radiographs taken 46 weeks after the corticosteroid injection. And then C to D, this is an example of a patient who had new right femoral head remodeling secondary to an unknown cause, and these radiographs were taken 13 weeks after the corticosteroid injection. On the left, we have a table of the demographics of the injection and control groups. As you can see, there is no significant difference in any baseline characteristics between the matched groups. On the right, once we included the patients with pre-existing avascular necrosis or subchondral insufficiency fracture, we were able to compare the groups in terms of our primary outcomes. Progression of osteoarthritis, new avascular necrosis or subchondral insufficiency fracture, femoral head collapse remodeling or remodeling, and septic arthritis. Importantly, in the injection group, only three patients experienced OA progression and only one experienced avascular necrosis, which did not significantly differ from the control group. And as a secondary analysis, we looked at the type of corticosteroid that was used as well as the dosage, and as you can see, there was no statistically significant difference between OA progression or any of our outcomes between the two different steroids used as well as the increasing dosage did not have an effect as none of the patients that received the 80mg dose with either steroid experienced any of our primary outcomes and you can also see the intra-observer reliability on the right between the radiologists that we're grading. In conclusion, we believe that corticosteroids are safe if used responsibly and that the previously reported rates of osteoarthritis progression, rapidly progressive osteoarthritis, and avascular necrosis with femoral head collapse associated with corticosteroid injections are grossly overreported.

intra-articular hip corticosteroid injections

safety

research

chondrotoxicity

osteoarthritis progression