A review of the efficacy of intraarticular hip injection for patients with hip osteoarthritis: to inject or not to inject in hip osteoarthritis?

Hip injection (HI) for osteoarthritis (OA) are in vogue nowadays. Corticosteroids (CSs) and hyaluronic acid (HA) gel are the two most common agents injected into the hip. Off late, platelet-rich plasma (PRP), mesenchymal stem cell (MSC), bone marrow aspirate concentrate (BMAC), local anesthetic (LA) agents, non-steroidal anti-inflammatory drugs (NSAIDs) and their different combinations have also been injected in hips to provide desired pain relief. However, there is a group of clinicians who vary of these injections. A search of the literature was performed on PubMed, Cochrane Library, and DOAJ using the keywords “hip osteoarthritis injection”. Data were analyzed and compiled. Intraarticular CSs are effective in providing the desired pain relief in OA hip, but repeated injections should be avoided and the interval between HI and hip arthroplasty must be kept for more than three months. Methylprednisolone or triamcinolone are combined with 1% lidocaine or 0.5% bupivacaine. Chondrotoxic effects of LA is a concern. Although national guidelines do not favor the use of HA for hip OA, numerous publications have favored its usage for a moderate grade of OA. The PRP, MSC, and BMAC are treatment options with great potential; however, currently, the evidence is conflicting on their role in hip OA. There is always a risk of septic arthritis, particularly when aseptic precautions are not followed, and clinicians must vary of this complication. The use of hip injection (HI) in the treatment of osteoarthritis (OA) has gained wide popularity. The relatively low cost, fast and simple method of pain relief are amongst its many advantages. Over time, the content of the injection has also evolved from local anesthetic (LA) agents to corticosteroids (CSs), hyaluronic acid (HA) and platelet-rich plasma (PRP).[1] The scope of use of injections in the hip region has grown from traditional aspiration to therapeutic injections. The two main substances used in recent times for pain relief are CSs and HA gel. For decades, low doses of CS were given to surgically unfit patients and to those who are not keen on joint replacement surgery.[2] The recent surge in the use of high-molecularweight HA for knee OA has been expanded as a treatment option for hip OA. The popularity of the administration of HA has been mounting with very little outcome data to support its use. Administration of HA injections has shown some promise in a selected subset of patients suffering from early OA of the hip.[3,4] Most papers report insufficient sample size and had a varied follow-up period which results in difficulty formulating and implementing national guidelines and clinical recommendations. Current literature advocates the safe use of CS injections for early hip OA.[5] Although there is no concrete evidence supporting HA injections, this has not dissuaded researchers from injecting PRP, mesenchymal stem cells (MSCs), LA agents, NSAIDS and many different combinations into the hip. The true extent of their benefits is still being debated.[6] In this review, we outline recent trends, discuss the role of HIs, and summarize complications of the technique.

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