Surgeons’ indications for and contraindications to the use of intra-articular steroid hip injection (IASHI]
| Survey question | Group of surgeons by years of experience; no. (and %) of surgeons | |||
|---|---|---|---|---|
| < 5 yr n = 11 | 5–10 yr n = 24 | > 10 yr n = 64 | Total n = 99 | |
| 1. What are your indications for hip injection? (check all that apply) | ||||
| Diagnostic, e.g., to sort out hip versus spine issue | 10 (90.9) | 21 (87.5) | 50 (78.1) | 81 (81.8) |
| Therapeutic — relief of pain | 9 (81.8) | 13 (54.2) | 43 (67.2) | 65 (65.7) |
| Patient not ready for surgery | 7 (63.6) | 8 (33.3) | 33 (51.6) | 48 (48.5) |
| Therapeutic — while waiting for arthroplasty | 8 (72.7) | 8 (33.3) | 26 (40.6) | 42 (42.4) |
| Patient can’t take arthritis pills | 6 (54.5) | 5 (20.8) | 30 (46.9) | 41 (41.4) |
| No success from other treatments (i.e., physiotherapy, pills) | 5 (45.5) | 4 (16.7) | 21 (32.8) | 30 (30.3) |
| Patient specifically requests procedure | 3 (27.3) | 5 (20.8) | 19 (29.7) | 27 (27.3) |
| Mainly used as an addition to other treatments | 4 (36.4) | 4 (16.7) | 19 (29.7) | 27 (27.3) |
| Mainly used after other treatments failed | 3 (27.3) | 5 (20.8) | 18 (28.1) | 26 (26.3) |
| Consider it as one primary arthritis-treatment option | 0 | 1 (4.2) | 1 (1.6) | 2 (2.0) |
| *Did not list any indications | 7 (7.1) | |||
| 2. Would you offer steroid hip injection more often, with the following types of arthritis: | ||||
| (a) Rheumatoid hip arthritis | ||||
| Inject more often | 4 (36.4) | 6 (25.0) | 10 (15.6) | 20 (20.2) |
| Inject less often | 2 (18.2) | 0 | 8 (12.5) | 10 (10.1) |
| This factor would not change my management | 4 (36.4) | 17 (70.8) | 42 (65.6) | 63 (63.6) |
| *Did not answer | 1 (9.1) | 1 (4.1) | 4 (6.2) | 6 (6.1) |
| (b) Osteoarthritis of the hip | ||||
| Inject more often | 2 (18.2) | 0 | 10 (15.6) | 12 (12.1) |
| Inject less often | 1 (9.1) | 0 | 8 (12.5) | 9 (9.1) |
| This factor would not change my management | 8 (72.7) | 19 (79.2) | 42 (65.6) | 69 (69.7) |
| *Did not answer | 0 | 5 (20.8) | 4 (6.2) | 9 (9.1) |
| (c) Avascular necrosis | ||||
| Inject more often | 0 | 0 | 2 (3.1) | 2 (2.0) |
| Inject less often | 5 (45.5) | 6 (25.0) | 34 (53.1) | 45 (45.5) |
| This factor would not change my management | 5 (45.5) | 16 (66.7) | 24 (37.5) | 45 (45.5) |
| *Did not answer | 1 (9.1) | 2 (8.3) | 4 (6.2) | 7 (7.1) |
| (d) If you suspect an effusion of the hip joint | ||||
| Inject more often | 2 (18.2) | 1 (4.2) | 22 (34.4) | 25 (25.3) |
| Inject less often | 0 | 4 (16.7) | 12 (18.8) | 16 (16.2) |
| This factor would not change my management | 1 (9.1) | 17 (70.8) | 25 (39.1) | 43 (43.4) |
| *Did not answer | 8 (72.7) | 2 (8.3) | 5 (7.8) | 15 (15.2) |
| 3. Type of radiographic findings; would you offer IASHI more often when (check all that apply) | ||||
| Mild arthritis | 9 (81.8) | 13 (54.2) | 34 (53.1) | 56 (56.6) |
| Cystic changes on radiographs | 0 | 4 (16.7) | 13 (20.3) | 17 (17.2) |
| Severe joint-space narrowing | 1 (9.1) | 4 (16.7) | 12 (18.8) | 17 (17.2) |
| Case with few or no osteophytes | 3 (27.3) | 1 (4.2) | 11 (17.2) | 15 (15.2) |
| 4. Repeat injection: | ||||
| (a) Would you give a second injection if the first one went well and the patient was agreeable? | 11 (100) | 16 (66.7) | 49 (76.6) | 76 (76.8) |
| (b) How long would you advise waiting before a second injection? | ||||
| 1–2 mo | 0/11 | 0/16 | 4/49 (8.2) | 4/76 (5.3) |
| 3–6 mo | 10/11 (90.9) | 14/16 (87.5) | 40/49 (81.6) | 64/76 (84.2) |
| > 6 mo | 1/11 (9.1) | 1/16 (6.3) | 4/49 (8.2) | 6/76 (7.9) |
| *Did not specify time period | 0/11 | 1/16 (6.3) | 1/49 (2.0) | 2/76 (2.6) |
| 5. IASHI and age of the patient with hip arthritis: | ||||
| Especially useful in a very young patient (< 40 yr) | 2 (18.2) | 5 (20.8) | 11 (17.2) | 18 (18.2) |
| Especially useful in a very old patient (> 85 yr) | 0 | 5 (20.8) | 12 (18.8) | 17 (17.2) |
| Age would not strongly influence my decision | 9 (81.8) | 12 (50.0) | 36 (56.3) | 57 (57.6) |
| *Did not answer | 0 | 2 (8.3) | 5 (7.8) | 7 (7.1) |
| 6. Do you feel there are reasons not to have IASHI? (open-ended question) | ||||
| Active infection or infection risk | 3 (27.3) | 14 (58.3) | 24 (37.5) | 41 (41.4) |
| Advanced/severe osteoarthritis | 2 (18.2) | 2 (8.3) | 5 (7.8) | 9 (9.1) |
| Allergy | 1 (9.1) | 3 (12.5) | 3 (4.7) | 7 (7.1) |
| Obesity | 1 (9.1) | 1 (4.2) | 2 (3.1) | 4 (4.0) |
| Radiology unavailable | 0 | 0 | 3 (4.7) | 3 (3.0) |
| Avascular necrosis | 0 | 0 | 2 (3.1) | 2 (2.0) |
| Upcoming hip surgery | 0 | 1 (4.2) | 1 (1.6) | 2 (2.0) |
| Age (not useful for young person) | 0 | 0 | 2 (3.1) | 2 (2.0) |
| Surgeons stating no contraindications to IASHI | 0 | 1 (4.2) | 1 (1.6) | 2 (2.0) |
| *No contraindications listed | 28 (28.3) | |||
↵* For each question, if the nonresponse rate was greater than 5%, then the nonresponse rate is listed as a separate row.