Fluoroscopically Guided Intra-articular Injection Helps Differentiate Pain Generator in Hip and Lumbar Pain
When patients present with leg pain, it can be difficult for doctors to learn if the pain is coming from hip or lumbar spine arthritis. X-rays, while indicating arthritis in both, cannot show which is causing the problems.
The authors of this study examined the records of 83 patients who underwent a fluoroscopically guided intra-articular injection in order to determine if the procedure helped locate the basis of the pain.
All patients had a diagnosis of hip and spine arthritis and had pain around the hip joint and/or gluteal area. All patients were followed for a minimum of 24 months after the procedure.
The injection into the hip joint was done in an operating room and the patients were all discharged one hour after the procedure. They returned for a follow up two weeks, six months, and 12 months after the injection, and then once a year after. If a patient had a later hip replacement, they were assessed at six weeks after the surgery as well.
Pain assessments were done with the visual analog scale (VAS), which rates the pain on a scale from zero to 10, with zero being no pain and 10 being the worst pain. The severity of the arthritis in the hip was measured using the Harris hip scores (HHS), a score out of 100, with 100 being the best possible score.
The 83 patients had a mean HHS score of 54.3 before the procedure. At two weeks after, 74 patients reported an improvement in pain from 7.4 to 2.7, on average, and an HHS improvement to 80.4. Nine patients did not report pain relief or improvement in HHS.
Among the 74 patients who experienced significant pain relief, 50 had a hip replacement later on; their HHS had dropped from the 80.4 at two weeks post-injection to 60.3 three months later; their pain score rose from 2.7 to 6.6. Only two patients who had a replacement did not report significant pain relief and their HHS was 61.3 after one year following the surgery.
Of the 74 patients who had pain relief and did not go on to have a hip replacement, 17 had a second injection when their pain returned, about six months after the first one. The nine patients who did not obtain relief and two others who did but still had pain after their hip replacement were referred to see spinal specialists.
Of these 11 patients, eight had injections or surgery on their spine while the remaining three managed their pain with medications.
The authors write that both hip and spinal arthritis can and do present with similar symptoms. They found, however, that those patients who had a limp were seven times more likely to have pain from the hip alone or from both the spine and the hip. The same was found among those with groin or limited internal rotation of the hips - they were 14 times more likely to have this problem.
Earlier studies have shown that treatment of the spine does not help if the problem originates from the hip, and the other way around. Therefore, it is important for the physicians to understand from where the pain is originating.
The authors conclude that their study shows the use of the injection can be an excellent aid in determining the origin of the pain.
Dhruv B. Pateder, MD, and Marc W. Hunderford, MD. Use of Fluoroscopically Guided Intra-articular Hip Injection in Differentiating the Pain Source in Concomitant Hip and Lumbar Spine Arthritis. In The American Journal of Orthopedics. November 2007. Vol. 36. No. 11. Pp. 591-593.