Response to Diagnostic Injection in Patients With Femoroacetabular Impingement, Labral Tears, Chondral Lesions, and Extra-Articular Pathology

doi:10.1016/j.arthro.2010.12.009

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 27, Issue 5, May 2011, Pages 619-627

https://doi.org/10.1016/j.arthro.2010.12.009 Get rights and content

Purpose

The purpose of this study was to compare the percent relief from injection among subjects with arthroscopic findings of femoroacetabular impingement (FAI) and labral and chondral pathologies while controlling for coexisting extra-articular pathology.

Methods

We retrospectively reviewed 72 consecutive subjects (54 female and 18 male subjects), aged 29.9 ± 10.4 years (range, 16 to 55 years), who underwent hip arthroscopy. Three separate analyses of covariance compared the percent relief after injection between groups based on surgically confirmed type of impingement (none, cam, pincer, or combined), labral pathology (none, mild, or torn), and chondral pathology (none, mild acetabular abnormality, acetabular delamination, or femoral lesion) while controlling for the presence of extra-articular pathology (iliotibial band, iliopsoas tendinopathy, or bursitis).

Results

The results of analysis 1 (F_3,67 = 1.96, P = .128, partial η² = .081) and analysis 2 (F_2,68 = 0.008, P = .992, partial η² = .000) indicated no significant main effect for FAI and labral pathology, respectively, on percent relief from injection. The results for analysis 3 indicated a significant main effect for chondral pathology of the hip on the percent relief from injection (F_3,67 = 3.03, P < .05, partial η² = .128). Post hoc analysis showed that those with mild chondral pathology of the acetabulum and those with acetabular delamination had significantly greater percent relief compared with those without chondral pathology. Extra-articular pathology did not influence the percent relief from injection in any of the analyses.

Conclusions

Subjects with chondral damage had greater relief from injection than those without, regardless of severity. The presence and severity of FAI and labral pathology did not influence the percent relief from injection. Concurrent extra-articular pathology did not alter the interpretation of the percent relief from injection. Therefore the interpretation and diagnostic value of an anesthetic injection in those with primary intra-articular pathology does not need to be altered by the presence of coexisting extra-articular hip pathology.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

Consecutive patients who underwent hip arthroscopy by a single orthopaedic surgeon specializing in hip arthroscopy for hip pain were retrospectively reviewed. All subjects underwent a presurgical evaluation that included clinical examination measures as described by Martin et al.¹⁵ and pertinent diagnostic imaging. Key components of the clinical examination included strength and range-of-motion measures of the hip, observation of gait and single-leg stance, and FAI tests. Impingement tests

Results

The results of analysis 1 indicate no significant main effect for FAI on percent relief from injection: F_3,67 = 1.96, P = .128, and partial η² = .081 (Table 2). Extra-articular pathology did not influence the reported percent relief: F_1,67 = 0.688, P = .410, and partial η² = .01. Similarly, the results of analysis 2 indicate no significant main effect for labral pathology: F_2,68 = 0.008, P = .992, and partial η² = .000 (Table 3). Again, the presence of extra-articular pathology did not

Discussion

This study is the first to quantify the response to an intra-articular anesthetic injection among patients classified by progressive stages of FAI and labral and chondral pathologies. Our primary purpose was to compare the response to anesthetic injection among patients with different sources and stages of intra-articular hip disease. The results supported our hypothesis that subjects with noted chondral damage would have greater relief from injection than those without chondral involvement.

Conclusions

Subjects with noted chondral damage had greater relief from injection than those without, regardless of severity. The presence and severity of FAI and labral pathology did not influence the variance of the percent relief from injection. Concurrent extra-articular pathology did not alter the interpretation of the percent relief from injection. Therefore the interpretation and diagnostic value of an anesthetic injection in those with primary intra-articular pathology do not need to be altered by

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Cited by (84)

Patient characteristics cannot predict the long-term effect of an intra-articular bupivacaine and corticosteroid injection in patients with femoroacetabular impingement: A retrospective cohort study
2023, Journal of Clinical Orthopaedics and Trauma
To evaluate predictors for effect of an intra-articular (IA) bupivacaine and corticosteroid injection in patients with femoroacetabular impingement syndrome (FAIS).
All patients between 18 and 50 years old with FAIS who received an intra-articular (IA) bupivacaine and corticosteroid injection between 2016 and 2019 were eligible for this retrospective study. Two groups were made, the non-arthroscopy group (patients for whom conservative treatment with physiotherapy and an IA bupivacaine and corticosteroid injection was sufficient) and the arthroscopy group (patients who needed an arthroscopy because conservative treatment and an IA bupivacaine and corticosteroid injection failed). Multiple regression analysis was performed to analyse the effect of the IA corticosteroid injection and to predict arthroscopic intervention based on sex, age, body mass index, duration of complaints, alpha angle and abnormal bone morphology.
In total 103 patients were included; 46 in the arthroscopy group and 57 in the non-arthroscopy group. The groups had similar baseline characteristics. A total of 37 (36%) patients had an effect of 3 months or longer from the IA corticosteroid injection; 31 (54%) were patients in the non-arthroscopy group versus 6 (13%) patients in the arthroscopy group (P < 0.001). Male sex seems to have an negative influence on the duration of the effect of the injection. None of the variables could significantly predict if a patient would undergo arthroscopic intervention (F(7,103) = 8.54, p = 0.3, R² = 0.11). The effect of the IA injection could not be predicted (p = 0.1; R² = 0.13).
There are no patient characteristics that predict who would and who would not benefit from the IA bupivacaine and corticosteroid injection in patients with FAIS and who would need an arthroscopic intervention within 1 year after the injection. Only male sex seems to have an negative influence on the duration of the effect of the injection.
Ultrasound and Ultrasound-Guided Hip Injection Have High Accuracy in the Diagnosis of Femoroacetabular Impingement With Atypical Symptoms
2021, Arthroscopy - Journal of Arthroscopic and Related Surgery
To evaluate the diagnostic value of ultrasound and ultrasound-guided hip injection in the diagnosis of femoroacetabular impingement (FAI) with atypical symptoms.
We evaluated consecutive patients diagnosed with FAI and with atypical symptoms who underwent ultrasound-guided hip injection between January 2017 and February 2019. All patients underwent systematic physical examination, ultrasound examination, magnetic resonance imaging (MRI) examination, and ultrasound-guided injection before surgery. Patients with positive response to ultrasound-guided hip injection were recommended to undergo arthroscopic surgery to treat intra-articular pathology. Sensitivity, specificity, accuracy, and positive predictive value (PPV) of ultrasound and MRI were calculated by using arthroscopic surgery as the gold standard. The accuracy of ultrasound-guided hip injection was recorded. Preoperative and postoperative patient-reported outcomes included visual analog scale for pain and modified Harris Hip Score.
A total of 78 patients with atypical symptoms were diagnosed with FAI. Among these 78 patients, 50 patients had positive responses to injection and 28 patients had negative responses to injection. A total of 36 patients finally underwent arthroscopic surgery. Response to the ultrasound-guided intra-articular injection was 91.7% accurate for detecting the presence of intra-articular abnormality. There were no complications of injection in any of the patients. The sensitivity, PPV, and accuracy by ultrasound diagnosis of cam impingement were 82.9%, 96.7%, and 80.6%, respectively. The sensitivity and accuracy by ultrasound diagnosis of anterosuperior labral tear were both 72.2%. For MRI diagnosis of cam impingement, the sensitivity, PPV and accuracy were 72.2%, 96.3%, and 74.3%, respectively. For MRI diagnosis of labral tear, the sensitivity and accuracy were both 88.9%. Thirty-four patients (94.4%) surpassed the minimal clinically important difference, and 33 patients (91.7%) achieved the patient acceptable symptomatic state.
Ultrasound and ultrasound-guided hip injection have high accuracy in the diagnosis of femoroacetabular impingement with atypical symptoms.
IV, case series.
Ultrasound-Guided Intra-Articular Injection of the Hip: The Nashville Sound
2019, Arthroscopy Techniques
Correlation Between Improvement in Pain After Ultrasound-Guided Intra-articular Hip Injection and Outcomes After Arthroscopy in Patients With Femoroacetabular Impingement
2024, Orthopaedic Journal of Sports Medicine
Injections prior to hip arthroscopy are associated with increased risk of repeat hip arthroscopy at 1 and 5 years
2024, Archives of Orthopaedic and Trauma Surgery
Clinical impact of diagnostic image-guided injections for musculoskeletal pain work-up in adolescent and adult patients at a children’s hospital: initial results
2024, Skeletal Radiology

View all citing articles on Scopus

: The authors report no conflict of interest.

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Original ArticleResponse to Diagnostic Injection in Patients With Femoroacetabular Impingement, Labral Tears, Chondral Lesions, and Extra-Articular Pathology

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Methods

Results

Discussion

Conclusions

Arthroscopy

Arthroscopy

Arthroscopy

J Arthroplasty

Arthroscopy

Arthroscopy

J Arthroplasty

Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology

Clin Orthop Relat Res

Use of fluoroscopically guided intra-articular hip injection in differentiating the pain source in concomitant hip and lumbar spine arthritis

Am J Orthop (Belle Mead NJ)

Reliability of clinical diagnosis in intraarticular hip diseases

Knee Surg Sports Traumatol Arthrosc

Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients

Am J Sports Med

Hip joint pain referral patterns: A descriptive study

Pain Med

Intra-articular bupivacaine hip injection in differentiation of coxarthrosis from referred thigh pain: A 10 year study

Acta Orthop Belg

Femoroacetabular impingement in adolescents and young adults

Orthop Nurs

The etiology of osteoarthritis of the hip: An integrated mechanical concept

Clin Orthop Relat Res

Original Article
Response to Diagnostic Injection in Patients With Femoroacetabular Impingement, Labral Tears, Chondral Lesions, and Extra-Articular Pathology