What is the evidence for intra-articular injection for femoral-acetabular impingement (FAI)?
AMSTAR Rating
Summary
Patient Population:
8 studies (6 cohort studies and 2 case series), 281 patients and 281 hips injected.
Intervention:
Intra-articular steroid (triamcinolone, methylprednisolone, betamethasone) with local anaesthetic or intra-articular hyaluronic acid.
Comparison:
No control groups were used in any of the studies.
In the diagnostic studies a comparison group was utilized.
Outcome:
Diagnostic:
- 4 studies: 3 ultrasound guided and 1 fluoroscopically guided
- Patients with FAI obtained greater pain relief from intra-articular steroid injection than those without FAI (mean relief, 85% vs 64%)
- patients with degenerative sequelae of FAI obtained significantly greater pain relief than those without chondral pathology (91% vs 76% relief; P < .05)
- Hyaluronic acid is as useful as gadolinium contrast for MRA diagnosis of FAI
- Patients with FAI obtained greater pain relief from intra-articular steroid injection than those without FAI (mean relief, 85% vs 64%)
Prognostic
- 1 study predicting functional and operative outcomes from pre-surgery steroid injection
- Positive response was a weak prognostic factor for successful surgical outcome (likelihood ratio 1.15).
- Negative response from an intra-articular hip injection was a stronger predictor of a poorer surgical outcome (likelihood ratio 0.57)
Therapeutic
- 3 studies used intra-articular steroids
- Pooled results of 2 studies found 15% (9/60) of patients had significantly decreased pain and found improvement in their numeric pain score, Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index and numeric rating scale outcomes at 6 weeks.
- 1 study used intra-articular hyaluronic acid
- Clinically significant improvement in visual analog scale and Harris Hip Score outcomes for all patients (23/23), relief sustained at 12 months (P < .05).
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Diagnostic
Useful as contrast for MRA
Prognostic
Positive response WEAK predictor of surgical response
Negative response BETTER predictor of poor surgical response
Therapeutic
Steroid (3 studies)
Hyaluronic acid (1 study)
Participant Information
their were 281 people.
their were 8 studies used.
