Are patients more likely to have hip osteoarthritis progression and femoral head collapse after hip steroid/anesthetic injections? A retrospective observational study

Simeone, F. A.; Vicentini, Joao R. T.; Bredella, Miriam A.; Chang, Connie Y.

doi:10.1007/s00256-019-03189-x

Cited by 44 publications

(57 citation statements)

References 26 publications

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“…Until now, there has been no effective treatment for knee arthrosis. Corticosteroid injections are widely used but damage cartilage [ 2 , 3 ], predispose to often devastating infection after TKA [ 4 , 5 ], are often associated with severe complications, such as stress fracture and avascular necrosis [ 6 , 7 , 8 , 9 ], and have been shown to accelerate arthrosis and increase the incidence of TKA [ 2 , 9 ]. Nonsteroidal anti-inflammatory medicines (NSAID) drugs are also widely used, but have high toxicity rates [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

Prodromos

Finkle

2020

Medicines

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Background: Osteoarthrosis (OA) of the knee afflicts millions worldwide. Total Knee Arthroplasty (TKA) is common, but associated with substantial cost and morbidity. Prior studies of intra-articular injection of fat, bone marrow aspirate (BMA), and platelet rich plasma (PRP) have shown clinical benefit. We hypothesized that injection of autologous adipose tissue, BMA, and PRP would provide significant benefit for patients with moderate knee OA resulting in avoidance of total knee arthroplasty (TKA) in most, with discontinuance of NSAIDs and other drugs. Methods: 42 TKA candidate patients (47 knees) with moderate (Kellgren-Lawrence 2 and 3) knee OA who had failed conservative treatment had autologous adipose tissue, BMA, and PRP injection as an alternative to TKA in office using only local anesthetic. Patients had discontinuance of all nonsteroidal anti-inflammatory medicines (NSAIDs) and other analgesics, except acetaminophen, prior to treatment. Patients were evaluated with Knee injury and Osteoarthritis Outcome Score Physical Shortform (KOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Single Assessment Numeric Evaluation (SANE) prior to treatment, and at 6 months, 1, and 2 years after treatment. Results: Follow up exceeded 80% at all time points. There were no significant adverse events. TKA was avoided in 97% at one and 86% at two years after treatment. Mean SANE, KOOS-PS, and WOMAC scores significantly improved at 6 months, 1, and 2 years post-treatment. WOMAC and SANE scores were higher at two versus one year post-treatment. Conclusions: Combined fat, BMA, and PRP injection is a safe and effective treatment for moderate knee OA, with reliable avoidance of TKA and possible continued improvement at two year follow-up.

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Section: Introductionmentioning

confidence: 99%

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

Prodromos

Finkle

2020

Medicines

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“…The short-term results of treatment with HA and corticosteroids require more frequent treatment, thereby increasing the risks of adverse events from treatment. Corticosteroids have been shown to accelerate the progression of osteoarthritis [ 4 , 5 ] and predispose to serious problems after joint replacement [ 6 , 7 , 8 , 9 , 10 , 11 ]. This study demonstrates that a single treatment of AMSCI can produce significant clinical improvement that can last at least 2 years.…”

Section: Discussionmentioning

confidence: 99%

“…HA has a variable effect, with low efficacy in many patients and a short (6-month) duration of effect [ 3 ]. Corticosteroid injections can damage cartilage [ 4 , 5 ], predispose to serious problems after a joint replacement [ 6 , 7 , 8 , 9 , 10 , 11 ], and have been shown to increase the incidence of joint replacement [ 4 , 10 ]. Therefore, there is an urgent need for a non-surgical treatment that is safe and more effective than these options.…”

Section: Introductionmentioning

confidence: 99%

Autologous Mesenchymal Stem Cell Treatment is Consistently Effective for the Treatment of Knee Osteoarthritis: The Results of a Systematic Review of Treatment and Comparison to a Placebo Group

et al. 2020

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Background: Numerous studies have used autologous mesenchymal stem cell injections (AMSCI) to treat osteoarthritis. We hypothesized that AMSCI is an effective osteoarthritis treatment with increasing efficacy at higher doses. Methods: We conducted a PubMed search for human clinical studies using AMSCI for the treatment of osteoarthritis (OA) and a second search for placebo arms of injectate OA treatment. Inclusion criteria included treatment outcomes ratings both pre-treatment and at least 6 months post-treatment. Results: 45 AMSCI cohorts from 34 studies met criteria. All AMSCI cohorts showed improvement at mean 15.3 months post-treatment. Mean WOMAC and VAS scores improved at 6-months and at final follow-up (p < 0.0001 for all). Scores > 2 years were also significant (WOMAC p = 0.001/VAS p = 0.004). Results greatly exceeded the minimal clinically important difference (MCID) at each time point. AMSCI improvement also substantially exceeded previously published 6-month placebo-treatment improvement. No dose–response relationship was seen. AMSCI cohorts showed continuing improvement ≥ 6 months, and continued upward at one year. Placebo scores were already trending downward by 6 months. Conclusions: AMSCI is a consistently significantly effective treatment for osteoarthritis. It should no longer be stated that data is insufficient to establish AMSCI efficacy for OA. Given its excellent safety profile, AMSCI should be widely used for the treatment of osteoarthritis.

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“…and a minority also developed joint surface collapse (9). To our knowledge, there are no analyses of large observational cohorts or prospective randomized controlled studies with mid-to long-term follow-up available that provide data from before and after IACS injection and compare patients undergoing injection to patients not undergoing injection or undergoing injection with a different agent with similar levels of disease activity and severity.…”

Section: Essentialsmentioning

confidence: 99%

“…Four radiologic entities have been reported after IACS injections of the knees and hips with a combined frequency of 8% in a recent noncontrolled case series of 459 IACS injections of the knee or hip (8,9), as follows: (a) rapid progressive OA (also termed accelerated OA) type 1 is defined on the basis of rapid loss of joint space on radiographs beyond the expected rate (ie, joint space loss of . 2 mm within a 12-month period [40]); (b) rapid progressive OA type 2 is defined as rapid articular destruction with accelerated bone loss not typically observed in patients with OA in a 12-month period (41); (c) complication of osteonecrosis, which is associated with subchondral femoral bone plate collapse and development of secondary OA; and (d) subchondral insufficiency fracture of the knee and hip, occult on radiographs at early stages and only recognized on MRI scans, which shows a subchondral hypointense fracture line of varying thickness and extent.…”

Section: Minimizing Potential Adverse Events On the Basis Of Imagingmentioning

confidence: 99%

Intra-articular Corticosteroid Injections for the Treatment of Hip and Knee Osteoarthritis-related Pain: Considerations and Controversies with a Focus on Imaging—Radiology Scientific Expert Panel

et al. 2020

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O steoarthritis (OA) is a highly prevalent, disabling, and costly condition that has been recognized by the United States Food and Drug Administration as a serious disease with unmet medical need (1-3). OA is understood as a disease of the whole joint, involving structural damage of the articular cartilage, subchondral bone, ligaments, capsule, synovial membrane, and periarticular muscles (4,5). Pain is the predominant symptom and is a major driving force in clinical decision making and health service attention (6). Current management of OA is primarily focused on symptom control. Intra-articular corticosteroid (IACS) injections are often used for pain management of hip and knee OA in patients who have not responded to oral or topical analgesics and are frequently intended to delay total joint replacement surgery if patients are young or hesitant to undergo surgery right away (7). A recent case series presented data on possible negative outcomes of IACS injection as perceived from a radiologic perspective (8). These findings included accelerated OA progression, subchondral insufficiency fracture, complications of pre-existing osteonecrosis, and rapid joint destruction including bone loss. Another recent uncontrolled retrospective observational study that focused on IACS injection of the hip and subsequent joint events reported that almost half of the patients treated with IACS injections exhibited signs of radiographic progression

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Are patients more likely to have hip osteoarthritis progression and femoral head collapse after hip steroid/anesthetic injections? A retrospective observational study

Cited by 44 publications

References 26 publications

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

Autologous Mesenchymal Stem Cell Treatment is Consistently Effective for the Treatment of Knee Osteoarthritis: The Results of a Systematic Review of Treatment and Comparison to a Placebo Group

Intra-articular Corticosteroid Injections for the Treatment of Hip and Knee Osteoarthritis-related Pain: Considerations and Controversies with a Focus on Imaging—Radiology Scientific Expert Panel

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