My doctor wants to delay hip replacement surgery for me as long as possible. I understand her thinking. I'm just not sure my hurting hip agrees. She has suggested trying a steroid injection (maybe up to three) first. I feel like I'm spinning the dial on this one. What do you suggest?
Steroid injections into a painful, arthritic hip are used as a diagnostic tool as well as an alternative to surgery. On the diagnostic side, if an injection directly into the hip reduces pain and improves motion and function, then it is clear the problem is coming from the joint and not the surrounding soft tissues. Sometimes a single injection is enough to give the patient months of relief, thus delaying the need for invasive surgery.
Whenever considering the use of steroid injections, the physician must carefully weigh the pros and cons, risks and benefits, and advantages and disadvantages of this treatment. Some studies have suggested a link between steroid injection into the hip before hip replacement and serious deep joint infection after hip replacement. One study reported a 30 per cent rate of hip infection after hip replacement when a steroid injection was given before the procedure.
Since that time, there has been increased caution on the part of orthopedic surgeons when considering steroid injection into the hip. The concern for joint infection after replacement is very real. Experts recommend using caution and good clinical judgment when using steroid injections to relieve hip pain for osteoarthritis. And surgeons are advised to avoid using this technique within a two month period of time before hip replacement.
Steroid injections into the hip before total hip replacement are not contraindicated. Proper patient selection and good, sterile technique when administering the injection(s) are probably two very important factors. Ultrasound or fluoroscopy (real-time X-rays) to make sure the injection goes into the hip may improve accuracy and outcomes. Special care must be given to keep everything sterile in order to reduce the risk of infection.
Stephen Croft, MD, and Peter Rockwood. Risk of Intraarticular Steroid Injection Before Total Hip Arthroplasty. In Current Orthopaedic Practice. March/April 2013. Vol. 24. No. 2. Pp. 185-188.
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