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Characterizing the Incidence of Avascular Necrosis after Corticosteroid Injections of the Hip

Christopher T Eberlin, BS
UNITED STATES

Characterizing the Incidence of Avascular Necrosis after Corticosteroid Injections of the Hip

Nathan Varady, MD, MBA, UNITED STATES Paul F Abraham, BS, UNITED STATES Ahab Chopra, BA, UNITED STATES Michael Peter Kucharik, BS, UNITED STATES Wendy Madeline Meek, BBA, UNITED STATES Christopher T Eberlin, BS, UNITED STATES David Freccero, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES Scott D Martin, MD, UNITED STATES

Department of Orthopaedic Surgery, Massachusetts General Hospital / Harvard Medical School, Boston, MA, UNITED STATES

2021 Congress Abstract Presentation 5 minutes Not yet rated

Anatomic Location

Hip / Groin / Thigh

Anatomic Structure

Cartilage

Diagnosis Method

X-ray MRI

Sports Medicine

Epidemiology

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Summary: This study presents the first baseline reference data on the nationwide incidence of AVN after intraarticular CSI of the hip and reveals numerous factors independently associated with increased risk, including type of hip pathology and female sex.

Introduction

Corticosteroid injections (CSIs) are a cornerstone in the treatment of numerous hip joint disorders that have failed other forms of conservative management. Notably, recent reports have shown extremely high rates of avascular necrosis (AVN) after CSIs of the hip. However, these studies contained select patient populations, and the absolute incidence of AVN after CSI of the hip has not been defined. Furthermore, whether there are differences in risk of AVN after CSI between various underlying disease states or other patient factors is unknown. Therefore, the purposes of this study were to characterize the nationwide incidence of AVN after hip CSI and to identify risk factors associated with increased risk of AVN development.

Methods

This retrospective cohort study identified all patients undergoing intraarticular CSIs of the hip in the MarketScan database from 2007-2017. Patient age, sex, geographic region, medical diagnoses, and surgeries were collected. The date and indication (osteoarthritis, unspecified pain, other derangements [labral injuries, loose-bodies, etc.]) for the patients’ first CSI were recorded. Cumulative incidence of new AVN was analyzed using Kaplan-Meier analyses censoring on database dropout or any hip surgery for a non-AVN indication. Cox-proportional hazard models were used for adjusted analyses including age, sex, region, year of first CSI, indication for first CSI, and number of subsequent CSIs. Patients with AVN at the time of first injection were excluded.

Results

We identified 143,905 patients undergoing CSI of the hip (65.1% female; median [interquartile range] age 53.0 years [45.0-59.0 years]). The most common indications for CSI were non-arthritis pain (64.8%) and osteoarthritis (32.3%). Across all patients, the one and two-year incidence of AVN was 1.8% (95% confidence interval [CI] 1.72%-1.88%) and 2.45% (95%CI 2.34%-2.55%), respectively. In adjusted analysis, age (hazard ratio [HR] 1.008 per additional year, 95% CI 1.004-1.013, p<0.001), female sex (HR 1.88, 95% CI 1.74-2.03, p<0.001), geographic region (p<0.001), number of additional CSIs (HR 1.08 per injection, 95% CI 1.06-1.1, p<0.001), and CSI indication (p<0.001) were associated with AVN risk. With respect to indication specifically, AVN rates were significantly higher for patients undergoing CSI for osteoarthritis than for joint derangements (HR 2.32, 95% CI 1.66-3.24, p<0.001)or non-arthritis pain (HR 1.71, 95% CI 1.58-1.86, p<0.001).

Discussion And Conclusion

AVN is a relatively rare event after CSI of the hip, as the nationwide one- and two-year incidence of AVN after hip CSI is approximately 1.8% and 2.45%, respectively. Importantly, AVN incidence varies markedly between CSI indication, with significantly higher rates for those undergoing injection for osteoarthritis, even when controlling for patient factors. These results may suggest that AVN is often a function of the underlying disease and/or patient population. Future studies examining the risk of AVN after hip CSI should account for injection indication, and randomized controlled trials would be useful in determining whether CSIs themselves play a causal role in these findings.

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Alpha Angle More Useful Than Femoral Head-Neck Offset to Predict Intra-Articular Damage in Patients with FAI Undergoing Hip Arthroscopy Abstract Presentation 5 minutes Jacob Shapira, MD, UNITED STATES Jade S Owens, BS, UNITED STATES David R. Maldonado, MD, UNITED STATES Philip Joseph Rosinsky, MD, UNITED STATES Hari Krishna Ankem, MD, UNITED STATES Bezalel Peskin, MD, ISRAEL Ajay C. Lall, MD, MS, FAAOS, UNITED STATES Benjamin G. Domb, MD, UNITED STATES
Endoscopic Iliopsoas Lengthening For Treatment Of Recalcitrant Iliopsoas Tendinitis After Total Hip Arthroplasty Abstract Presentation 5 minutes Marc R. Safran, MD, Prof., UNITED STATES John Carlo Bonano, MD, UNITED STATES Christopher Jamero, MA, ATC, UNITED STATES Nicole Alexandria Segovia, BA, UNITED STATES James I. Huddleston, MD, UNITED STATES
Results After Arthroscopic Treatment Of Iliopsoas Impingement After Total Hip Arthroplasty ePoster Presentation Wolfgang Miehlke, MD, GERMANY Christian Sobau, MD, GERMANY Alexander Zimmerer, MD, GERMANY
Sex- And Age-Based Differences In Outcomes And Survivorship Following Primary Hip Arthroscopy At Short And Mid-Term Follow-Up: A Comparative Analysis ePoster Presentation David R. Maldonado, MD, UNITED STATES Jade S Owens, BS, UNITED STATES Cammille Go, BA, UNITED STATES Benjamin G. Domb, MD, UNITED STATES
Assessing Risk Of Osteonecrosis Of The Hip Following Intraarticular Injections: Hyaluronic Acid Versus Corticosteroid Abstract Presentation 5 minutes Nathan Varady, MD, MBA, UNITED STATES Ahab Chopra, BA, UNITED STATES Paul F Abraham, BS, UNITED STATES Michael Peter Kucharik, BS, UNITED STATES Christopher T Eberlin, BS, UNITED STATES David Freccero, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES Scott D Martin, MD, UNITED STATES
A Systematic Review Of Terminology, Surgical Techniques, Preoperative Diagnostic Measures, And Geographic Differences In The Treatment Of Athletic Pubalgia/Sports Hernia/Core Muscle Injury/Inguinal Disruption ePoster Presentation Matthew J. Kraeutler, MD, UNITED STATES Omer Mei-Dan, MD, UNITED STATES John W. Belk, BA, UNITED STATES Christopher M. Larson, MD, UNITED STATES Toghrul Talishinskiy, MD, UNITED STATES Anthony Scillia, UNITED STATES
The Surgeon Mentor Program: Outcomes of Total Hip Arthroplasty via the Direct Anterior Approach ePoster Presentation Christopher J. Wilson, A/Prof, MBChB, MRCS, FRACS, PhD, AUSTRALIA Melinda Jiang, MD, AUSTRALIA Mark Inglis, FRACS BMBS B Med Sci FOrthoA, AUSTRALIA David Morris, MD, AUSTRALIA Nathan Eardley-Harris , MBBS, MClinSc, AUSTRALIA
The Relationship Between Early And Mid-Term Hip Arthroscopy Outcomes: Employing 3 Month Follow-Up To Predict Mid-Term Results Abstract Presentation 5 minutes Mario Hevesi, MD, PhD, UNITED STATES Ajay C. Lall, MD, MS, FAAOS, UNITED STATES David E. Hartigan, MD, UNITED STATES Bruce A. Levy, MD, UNITED STATES Benjamin G. Domb, MD, UNITED STATES Aaron J. Krych, MD, UNITED STATES
Long Term Outcomes After Arthroscopic Treatment Of Femoroacetabular Impingement For Patients With Borderline Dysplasia Abstract Presentation 4 minutes Ryan S. Selley, MD, UNITED STATES Molly A Day, MD, UNITED STATES Reena Olsen, BS, UNITED STATES Stephanie S Buza, MD, UNITED STATES Bryan T. Kelly, MD, UNITED STATES Anil S. Ranawat, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Can Intra-Articular Gadolinium Confound The Results Of A Diagnostic Anesthetic Injection In Young Patients With Hip Pain? Abstract Presentation 5 minutes Daniel Curtis, MD, UNITED STATES William Michael Pullen, MD, UNITED STATES Christopher Jamero, MA, ATC, UNITED STATES Marc R. Safran, MD, Prof., UNITED STATES
No Difference In Minimum Two-Year Patient-Reported Outcome Scores Between Circumferential And Segmental Labral Reconstruction For The Management Of Irreparable Labral Tear And Femoroacetabular Impingement Syndrome In The Primary Setting. ePoster Presentation David R. Maldonado, MD, UNITED STATES Cynthia Kyin, BA, UNITED STATES Jacob Shapira, MD, UNITED STATES Mitchell Meghpara, MD, UNITED STATES Philip Joseph Rosinsky, MD, UNITED STATES Ajay C. Lall, MD, MS, FAAOS, UNITED STATES Benjamin G. Domb, MD, UNITED STATES
Persistent Post-Operative Opioid Use Following Hip Arthroscopy Is Common And Is Associated With Pre-Operative Opioid Use And Age ePoster Presentation Ryan M. Degen, MD, FRCSC, CANADA J. Andrew McClure, MSc, CANADA Britney Le, MSc, CANADA Blayne Welk, MD, CANADA Jacquelyn Marsh, PhD, CANADA
Covid Mortality Among Neck Of Femur Fractures During The Pandemic 2019 Abstract Presentation 5 minutes Aashish Raghu, MBBS, MS, MRCS, FRCS (Tr & Orth), UNITED KINGDOM Anas Hassan, MBBS, MRCS, UNITED KINGDOM Nicholas Dr Roeck, MB ChB, FRCS (ENG), FRCS (Tr&Orth), UNITED KINGDOM Mohamed Antar, MBBS, Master of Orthopaedics, MRCS, UNITED KINGDOM
Surgical Treatment of High-Grade Acute Intramuscular Hamstring Tendon Injuries in Athletes ePoster Presentation Randeep Singh Aujla, MBChB ChM FRCS (Tr&Orth) MFSEM, UNITED KINGDOM Steven Cecchi, BSc (Hons), MBBS, AUSTRALIA Peter Alberto D'Alessandro, MBBS Hons. (UWA) FRACS FAOrthA, AUSTRALIA Peter T. Annear, FRACS(Orth), AUSTRALIA
Female Athletes Demonstrate Greater Improvement in Patient Reported Outcome Scores and Equal Return To Sport Rates Compared to Males After Hip Arthroscopy A Gender Based Matched Comparison of High-Level Athletes Abstract Presentation 4 minutes Andrew Jimenez, MD, UNITED STATES Rachel Glein, BS, UNITED STATES Kara Miecznikowski, BS, UNITED STATES Benjamin Saks, MD, UNITED STATES Hari Krishna Ankem, MD, UNITED STATES Payam William Sabetian, MD, GUATEMALA Benjamin G. Domb, MD, UNITED STATES
Evaluation of endoscopically gluteus medius repair in patients with Femoro-acetabular impingement and labrum detachment ePoster Presentation George D. Tsikouris, MD, GREECE Nikolaos D. Gravvanis, MD, GREECE Georgia S. Dedousi, MD, GREECE Panagiota Vlaserou, BSc in Physiotherapy, MSc Biomedical Engineer, GREECE Fanis P. Papadakis, BSc, MSc(cand.), GREECE Ioannis K. Antonopoulos, GREECE Vassilis N. Psychoyios, MD, GREECE Theodoros G. Troupis, Prof, GREECE
Hip Osteochondroplasty May Benefit The Non-Ideal Patient With Femoroacetabular Impingement: Analysis From The Embedded Prospective Cohort Of The First Trial Abstract Presentation 6 minutes Mahmoud Almasri, MD, FRCSC, UNITED STATES Nicole Simunovic, MSc, CANADA Diane Heels-Ansdell, MSc, CANADA Olufemi R. Ayeni, MD, PhD, MSc, FRCSC, CANADA FIRST Investigators, MD, CANADA
The Radiographical Influence Of Torsional Deformity Of The Acetabular And Femur In Dysplastic Hips ePoster Presentation Carsten Heimer, BA, GERMANY Carsten Perka, MD, PhD, GERMANY Henrik Baecker, MD, GERMANY
Outcome Measures After Proximal Hamstring Repair: A Systematic Review ePoster Presentation Tara Reza, MPH, UNITED STATES Andre Gordon Perez-Chaumont, BS, UNITED STATES Andrew J Hinkle, BS, UNITED STATES Symone M Brown, MPH, UNITED STATES Mary K. Mulcahey, MD, UNITED STATES

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Characterizing the Incidence of Avascular Necrosis after Corticosteroid Injections of the Hip

Characterizing the Incidence of Avascular Necrosis after Corticosteroid Injections of the Hip

Introduction

Methods

Results

Discussion And Conclusion

More 2021 Congress Hip Abstract Presentations

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Characterizing the Incidence of Avascular Necrosis after Corticosteroid Injections of the Hip

Characterizing the Incidence of Avascular Necrosis after Corticosteroid Injections of the Hip

Introduction

Methods

Results

Discussion And Conclusion

More ISAKOS 2021: Global Content