Correctly placed steroid injections can produce considerable improvement in patients with osteoarthritis (OA) of the hip, according to Canadian researchers.

Correctly placed steroid injections can produce considerable improvement in patients with osteoarthritis (OA) of the hip, according to Canadian researchers.

"Historically, using steroids to treat hip OA didn't seem to work very well," lead investigator Dr. Robert G. W. Lambert told Reuters Health, "at least not as well as in the knee. However, the hip joint is one of the most difficult joints in the body to inject accurately."

"The big question," he added, was whether the steroid was less effective "just because of how it was injected." As he and his colleagues at the University of Alberta, Edmonton note in the July issue of Arthritis and Rheumatism, "entry of the therapeutic agent into the synovial space cannot be ensured without fluoroscopic guidance."

Dr. Lambert and colleagues studied 52 symptomatic patients with hip OA who were randomized in a double-blind fashion to fluoroscopically guided intra-articular injection of bupivacaine and 40 mg triamcinolone or to bupivacaine and saline.

At two months, Western Ontario and McMaster Universities OA Index (WOMAC) pain scores fell by 49.2 per cent in the active treatment group and by 2.5 per cent in the placebo group.

In addition, 67.7 per cent of the corticosteroid group showed a 20 per cent WOMAC improvement, compared to 23.8 per cent of the placebo group. Findings were similar for a 50 per cent WOMAC improvement (61.3 versus 14.3 per cent).

These differences were maintained at three months, with significant between-group differences in WOMAC stiffness and physical function scores and in physical quality-of-life scores.

"Our trial," continued Dr. Lambert, "confirms that when you inject the steroid under image guidance -- in our case using X-rays -- and can be certain that the steroid is in the right place, the steroids work very well indeed for most patients with moderately advanced or severe hip OA."

Meanwhile, he noted, "We have not tested steroid use in early disease, which is a very different situation, and currently do not recommend using steroids in early OA.