Risk of avascular necrosis of the femoral head after intra-articular steroid injection
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1
Borders General Hospital, Trauma and Orthopaedic Department, United Kingdom
Background:{BR}Intra-articular steroid injection with local anaesthetic is commonly used as a diagnostic tool to differentiate between hip and spine pathology. The aim of our study was to identify the risk of avascular necrosis (AVN) after intra-articular steroid injection of the hip.{BR}Methods: {BR}We conducted a retrospective review of 103 patients who underwent intra-articular steroid injection of the hip from 2007 to 2010 (without radiographic signs of AVN before the injection) in a district general hospital. The grade of the osteoarthritis was recorded pre and post injection using the Kellgren and Laurence radiological classification. A control group of 103 patients matched for age, gender, and grade of osteoarthritis was used for comparison. Patient's notes were reviewed to identify the risk factors for AVN.{BR}Results: {BR}The mean age was 67.9 years and 68% were female. The mean time between radiographs was 21.9 months for the injection group and 19.3 months for the control group. Eight patients (7.8%) in the injection group developed AVN, of which only one had an identifiable risk factor. The risk of developing AVN after steroid injection was significantly higher. (OR 8.6, p=0.041). The mean grade of the osteoarthritis progressed from 2.1 to 2.7 in the injection group and from 2.2 to 2.9 in the control group.{BR}Conclusion: {BR}Intra-articular steroid injection of the hip carries a significant risk of AVN of the femoral head and should be used cautiously. Further studies using micro CT scan to look at the micro fractures following intraarticular steroid injections leading to AVN are needed.
Keywords:
Bones,
Bone Research
Conference:
2011 joint meeting of the Bone Research Society & the British Orthopaedic Research Society, Cambridge, United Kingdom, 27 Jun - 29 Jun, 2011.
Presentation Type:
Poster
Topic:
Abstracts
Citation:
Mackenzie
S,
Akhtar
M,
Clement
N,
Kerr
A,
Tiemessen
C and
Mehdi
S
(2011). Risk of avascular necrosis of the femoral head after intra-articular steroid injection.
Front. Endocrinol.
Conference Abstract:
2011 joint meeting of the Bone Research Society & the British Orthopaedic Research Society.
doi: 10.3389/conf.fendo.2011.02.00042
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Received:
30 Sep 2011;
Published Online:
30 Sep 2011.
*
Correspondence:
Dr. MA Akhtar, Borders General Hospital, Trauma and Orthopaedic Department, United Kingdom, m_adeel_akhtar@yahoo.com