Comparing the Risk of Osteonecrosis of the Femoral Head Following Intra-Articular Corticosteroid and Hyaluronic Acid Injections

• DOI: 10.2106/jbjs.21.01043
• Publication Date: 2022-03-11T19:02:22Z
• Authors: Nathan H. Varady; Paul F. Abraham; Michael P. Kucharik; David M. Freccero; Eric L. Smith; Scott D. Martin
• Keywords: Cumulative incidence; Hip Arthroscopy

Although intra-articular corticosteroid injections (CSIs) are a cornerstone in the nonoperative management of hip pathology, recent reports have raised concerns that they may cause osteonecrosis femoral head (ONFH). However, these studies might been limited by nonrepresentative patient samples. Therefore, purpose this study was to assess incidence ONFH after CSI and compare it with similar population received non-CSI injection.This retrospective propensity-matched cohort patients MarketScan database who underwent an injection from 2007 2017. Patients receiving CSIs were matched 4:1 hyaluronic acid (HAIs) based on age, sex, geographic region, comorbidities, type year, baseline follow-up time using propensity scores. The patients' first identified, development analyzed Kaplan-Meier curves Cox proportional-hazards models. history or those both types excluded.A total 3,710 undergoing included (2,968 742 HAIs; mean [standard deviation] 53.1 [9.2] years; 55.4% men). All factors successfully between groups (all p > 0.57). estimated cumulative (95% confidence interval [CI]) for HAI 2.4% (1.8% 3.1%) versus 2.1% (1.1% 3.5%) at 1 year 2.9% (2.2% 3.7%) 3.0% (1.7% 4.8%) 2 years (hazard ratio, 1.05; 95% CI, 0.59 1.84; = 0.88). results held across range sensitivity analyses.The HAIs. could not determine whether themselves (regardless drug used) lead ONFH, suggest often be due, part, natural course underlying disease. Future randomized controlled trials needed definitively answer question; interim, clinicians reassured continue judicious use as clinically indicated.Therapeutic Level III. See Instructions Authors complete description levels evidence.