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Fernandes DA, Martins EC, Melo G, Locks R, Adam GP, Neves FS. Diagnostic Capability of Intra-Articular Injections for Femoroacetabular Impingement Syndrome: A Systematic Review. Clin J Sport Med 2024:00042752-990000000-00192. [PMID: 38810122 DOI: 10.1097/jsm.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 04/28/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To review and critically appraise available literature concerning the diagnostic capability of intra-articular injections for femoroacetabular impingement (FAI) syndrome. DESIGN Systematic review. SETTING N/A. PARTICIPANTS N/A. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Studies assessing pain relief following intra-articular injections for the diagnosis of FAI syndrome, compared with arthroscopy as diagnostic reference standard, were considered eligible. Searches were performed across 8 databases, and the risk of bias was evaluated through the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS From 489 articles identified, 4 were included for analysis. Intra-articular injections were composed of anesthetic agents (such as lidocaine, bupivacaine, and ropivacaine), combined or not with corticosteroids (triamcinolone and betamethasone). All studies were judged as "at risk of bias", and a substantial heterogeneity was found considering assessment methods and pain relief thresholds for a positive response to intra-articular injections. Overall, 2 studies reported that intra-articular injections presented a high accuracy in determining the presence of FAI syndrome. However, the remaining 2 studies indicated that intra-articular injections might present restricted diagnostic capability to discriminate FAI syndrome from healthy individuals or those with other hip pathologies. CONCLUSIONS Based on limited evidence, the diagnostic capability of intra-articular injections for FAI syndrome cannot be supported. It remains unclear which pain relief thresholds are related to a higher diagnostic capability. The combination of anesthetics with corticosteroids should also be further explored, including multiple pain assessments for evaluation of prolonged effects.
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Affiliation(s)
- Daniel Araujo Fernandes
- Department of Surgery, Federal University of Santa Catarina (UFSC), Biomechanical Engineering Laboratory (LEBm-UFSC), Postgraduate Program in Medical Sciences (PPGCM-UFSC), Florianópolis, Santa Catarina, Brazil
| | - Eduardo Campos Martins
- Medical School, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Gilberto Melo
- Department of Public Health, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Renato Locks
- Department of Orthopaedics, Regional Hospital of São José Dr Homero de Miranda Gomes, Florianópolis, Santa Catarina, Brazil
| | | | - Fabrício Souza Neves
- Internal Medicine Department, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
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Takla A, Gunatilake K, Ma N, Moaveni A. Can intra-articular hip injections predict arthroscopy outcomes for femoroacetabular impingement syndrome? A systematic review. J Orthop 2024; 50:122-129. [PMID: 38214002 PMCID: PMC10776375 DOI: 10.1016/j.jor.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/08/2023] [Indexed: 01/13/2024] Open
Abstract
Background Femoroacetabular Impingement (FAI) syndrome represents a prevalent aetiology of hip discomfort observed among both adolescent and adult populations. It is initially managed conservatively with oral anti-inflammatories and physiotherapy; some patients proceed to receiving an intra-articular (IA) hip injection, but ultimately, the gold-standard treatment is hip arthroscopy. Study design Systematic Review. Purpose To systematically investigate the relationship between response to IA anaesthetic or steroid hip injections and arthroscopy outcomes for FAI syndrome. Methods A systematic search of PubMed, Medline, CINAHL, SCOPUS, and Cochrane was conducted in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Results Seven studies (Level II-IV) were identified that met our inclusion and exclusion criteria. These studies collectively included 637 patients, demonstrating an average age of 37.5 years (and a range of 14-72 years). Two of the seven studies reported a statistically significant positive correlation between response to IA injections and arthroscopy outcomes. The remaining five studies found that although a positive IA injection response increased the odds of a good outcome post arthroscopy (defined across various studies as a post-operative modified Harris Hip score of >70 points, >79 points or an improvement by 8 or more points), this correlation was not statistically significant. Conclusion IA hip injections can be a useful prognostic tool, though they are not a consistently reliable predictor of which patients will have good arthroscopic outcomes.
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Affiliation(s)
- Antony Takla
- The Alfred Hospital, Department of Orthopaedic Surgery, Australia
- Monash Bioethics Centre, Monash University, Australia
| | - Karin Gunatilake
- The Alfred Hospital, Department of Orthopaedic Surgery, Australia
| | - Norine Ma
- The Alfred Hospital, Department of Orthopaedic Surgery, Australia
| | - Ash Moaveni
- The Alfred Hospital, Department of Orthopaedic Surgery, Australia
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Martins EC, Gomes DA, de Brito Fontana H, Fernandes DA. Does response to preoperative intra-articular anesthetic injections predict outcomes of femoroacetabular impingement syndrome? Arch Orthop Trauma Surg 2023; 143:6283-6294. [PMID: 37316693 DOI: 10.1007/s00402-023-04927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Some patients with femoroacetabular impingement syndrome (FAIS) who undergo surgery do not show satisfactory outcomes. Reliable tests that can inform prognosis of FAIS surgery are needed for optimized indications and contraindications to surgery. We aimed to review and critically appraise available literature on the capability of patient response to preoperative intra-articular anesthetic injections (PIAI) to predict post-surgical outcomes in patients with FAIS. MATERIALS AND METHODS This study was conducted in accordance with the PRISMA statement. Studies that assessed the patient pain response to PIAI and post-surgical outcomes in patients with FAIS were considered eligible. Study selection and data collection were performed by three independent reviewers. Main outcomes evaluated were those measured by hip outcome scales often used in assessing postoperative pain and functional recovery, such as the modified Harris Hip Score (mHHS) and international Hip Outcome Tool (iHOT). The likelihood ratio of achieving satisfactory postoperative outcomes at the mHHS (LHR) was extracted or calculated-for patients with significant response to PIAI and for those without a significant response to PIAI. The risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool. RESULTS Six studies were considered eligible for analysis. Five studies indicated that patient response to PIAI are associated to surgical outcomes for patients with FAIS, with a greater reduction in pain typically indicating a better surgical outcome. Additionally, the LHR ranged from 1.15 to 1.92 for patients with significant response to PIAI (I2 = 90.6%). For patients without a significant response, the LHR ranged from 0.18 to 0.65 (I2 = 87.5). An overall high risk of bias was observed for all studies included in the analysis. Study attrition, the prognostic factor measurement and the presence of confounding factors were the main sources of bias. CONCLUSIONS Greater reductions in pain with preoperative intra-articular anesthetic injections were found to be associated to better outcomes after FAIS surgery, but all available studies contain a high risk of bias.
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Affiliation(s)
- Eduardo Campos Martins
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, CEP: 88040-900, Brazil.
- Department of Surgery, Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Trindade, Florianópolis, Santa Catarina, CEP: 88036-800, Brazil.
| | - Diogo A Gomes
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, CEP: 88040-900, Brazil
| | - Heiliane de Brito Fontana
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, CEP: 88040-900, Brazil
| | - Daniel Araujo Fernandes
- Department of Surgery, Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Trindade, Florianópolis, Santa Catarina, CEP: 88036-800, Brazil
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Berthelot JM, Brulefert K, Arnolfo P, Le Goff B, Darrieutort-Laffite C. Update on contribution of hip labral tears to hip pain: A narrative review. Joint Bone Spine 2023; 90:105465. [PMID: 36150666 DOI: 10.1016/j.jbspin.2022.105465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/07/2022] [Accepted: 09/05/2022] [Indexed: 01/19/2023]
Abstract
Hip labral tears are found in 22-55% of individuals with hip pain, but labral tears without cysts are usually not responsible for hip pain, which originates mostly from other structures than the torn labrum, like osteochondral, but also tendinous injuries (rectus femoris, gluteus minimus, iliopsoas) or capsulo-ligamentous tears (iliofemoral ligaments, ligament teres). Those lesions are mainly the consequences of underlying unrecognized functional acetabular dysplasia, and/or femoroacetabular impingements. Although the early repair of labral tears in young sportsmen induces a marked and lasting relief, and might delay the onset of osteoarthritis, the microinstability fostered by labral damages seems less important than underlying dysplasias/impingements. This narrative review details recent findings on: (i) the various mechanisms of pain associated with labral tears; (ii) few evidence for hip microinstability induced by isolated labral tears; (iii) how to best detect labral tears, both clinically (including through IROP test) and on imaging (MRI, MRA, computed tomography arthrography, ultrasound). Some authors suggested to use pull-out tests during surgery, but pulling of hips do not seem to increase much diagnostic performances of ultrasounds. Ultrasound-guided intra-articular and peri-articular injections may tell how often hip pain is exclusively induced by peri-capsular injuries secondary to the acetabular dysplasia/femoro-acetabular impingements already responsible for labral tears. Further works could tell whether labral repair, tendinous debridement, plication of capsule, and/or focal denervation, may induce lasting reliefs of pain induced by the chronic contraction of surrounding muscles (rectus femoris, gluteus minimus, psoas), whose deep aponeuroses mix with the superficial fibres of the thick hip capsule.
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Affiliation(s)
- Jean-Marie Berthelot
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France.
| | - Kevin Brulefert
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France
| | - Paul Arnolfo
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France
| | - Benoît Le Goff
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France
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Mujahed T, Hassebrock JD, Makovicka JL, Pollock JR, Wilcox JG, Patel KA, Economopoulos KJ. Preoperative Intra-articular Steroid Injections as Predictors of Hip Arthroscopy: 2-Year Outcomes. Orthop J Sports Med 2021; 9:23259671211053817. [PMID: 34881337 PMCID: PMC8647274 DOI: 10.1177/23259671211053817] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In patients with femoroacetabular impingement, preoperative diagnostic injections are commonly used to establish a diagnosis of intra-articular pathology. In some cases, intra-articular steroid injections are also used for therapeutic purposes. PURPOSE/HYPOTHESIS The purpose of this study was to determine if a positive response to intra-articular steroid injection was predictive of superior outcomes after hip arthroscopy to determine if the response to intra-articular steroid injection was predictive of outcomes after hip arthroscopy. It was hypothesized that a positive response to a preoperative hip injection would be predictive of improved short- to midterm outcomes after hip arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This was a retrospective study of 208 patients who elected to have ultrasound-guided intra-articular steroid injection before they underwent hip arthroscopy between January 2016 and December 2016. Patients were divided into 2 groups: those who showed improvement in pain after the injection (steroid responder group) and those who showed no response (nonresponder group). The authors compared the preoperative and 2-year postoperative patient-reported outcomes (modified Harris Hip Score [mHHS] and Hip Outcome Score-Activities of Daily Living [HOS-ADL]) and radiographic findings between groups. Clinical endpoints, including rates of revision and conversion to total hip arthroplasty, were also reviewed. RESULTS There were 88 patients in the nonresponder group and 120 patients in the responder group, with no significant between-group differences in preoperative descriptive variables. The responder group had significantly higher 2-year mHHS and HOS-ADL, pre- to postoperative change in mHHS and HOS-ADL, percentage of patients achieving the patient acceptable symptomatic state (PASS) on the mHHS, and percentage of patients reaching the minimum clinically important difference and the PASS on the HOS-ADL. There was no difference in Tönnis grade, acetabular labrum articular disruption grade, revision rate, or conversion to total hip arthroplasty between the 2 groups. CONCLUSION The response to preoperative intra-articular injection did aid in predicting 2-year patient-reported outcomes of hip arthroscopy for femoroacetabular impingement. Overall, the result of a preoperative intra-articular injection can be a helpful clinical tool for surgical decision-making and counseling patients on expected outcomes after hip arthroscopy.
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Affiliation(s)
- Tala Mujahed
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | | | | | | | - Justin G. Wilcox
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Karan A. Patel
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Makovitch SA, Mills CA, Eng C. Update on Evidence-Based Diagnosis and Treatment of Acetabular Labral Tears. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Prediction of intra-articular pathology and arthroscopic outcomes for femoroacetabular impingement and labral tear based on the response to preoperative anaesthetic hip joint injections. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:601-602. [PMID: 32918602 DOI: 10.1007/s00590-020-02790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022]
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