Clinical Effectiveness of Ultrasound-guided Intra-articular Corticosteroid and Local Anaesthetic Injections for Hip Osteoarthritis: A Randomised Controlled Trial (HIT)

Zoe Paskins ¹, Kieran Bromley ², Martyn Lewis ², Gemma Hughes ², Emily Hughes ², Andrea Cherrington ², Alison Hall ², Melanie Holden ³, Raymond Oppong ⁴, Kay Stevenson ², Ajit Menon ⁵, Philip Roberts ⁶, George Peat ², Clare Jinks ⁷, Nadine Foster ², Christian Mallen ⁸ and Edward Roddy⁹, ¹Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom, ²Keele University, Keele, United Kingdom, ³Research Institute for Primary Care and Health Sciences and Keele CTU, Keele University, Keele, England, United Kingdom, ⁴University of Birmingham, Birmingham, United Kingdom, ⁵Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, United Kingdom, ⁶University Hospitals North Midlands NHS Trust, Stoke-on-Trent, United Kingdom, ⁷Research Institute for Primary Care and Health Sciences, Keele University, Keele, England, United Kingdom, ⁸Research Institute for Primary Care and Health Sciences, Keele University, UK, Keele, United Kingdom, ⁹Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit, Keele, United Kingdom

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Hip and corticosteroids, Osteoarthritis

Session Information

Date: Tuesday, November 12, 2019

Title: 5T090: Osteoarthritis – Clinical II: Novel Therapies (2756–2761)

Session Type: ACR Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Evidence of the effectiveness of intra-articular corticosteroid injection for hip osteoarthritis (OA) is limited and conflicting. The HIT trial compared the clinical effectiveness of an ultrasound-guided intra-articular hip injection (USGI) of 40mg triamcinolone acetonide and 4ml 1% lidocaine hydrochloride combined with best current treatment (BCT) with (i) BCT alone (primary objective) and (ii) an USGI of 5ml 1% lidocaine only combined with BCT (EudraCT: 2014–003412-37).

Methods: This was a pragmatic, three-arm, single-blind, randomised controlled trial in adults with painful hip OA recruited from community musculoskeletal services and primary care. Participants were randomised equally to one of three treatment groups: (1) BCT alone, (2) BCT plus USGI of triamcinolone and lidocaine, or (3) BCT plus USGI of lidocaine only. Outcomes were collected postally at 2 weeks, 2, 4 and 6 months. The primary outcome was self-reported current hip pain intensity (0-10 numeric rating scale (NRS)) over 6 months (repeated measures analysis). Secondary outcomes included pain, stiffness and physical function (Western Ontario and McMaster University Arthritis Index, WOMAC), patient’s global impression of change, and pain self-efficacy. 204 participants were required to detect a minimum difference of 1 point in mean pain NRS score between arms (1) and (2) with 80% power (5% two-tailed significance level, 15% loss to follow-up). Analysis was by intention-to-treat.

Results:

199 participants were recruited (43% male, mean age 63 years), 67 to arms (1) and 66 each to arms (2) and (3). Primary outcome completion rates were 95% at 2 weeks, 94% at 2 months, 90% at 4 months, and 89% at 6 months.

Greater mean improvement in hip pain intensity (0-10 NRS) over 6 months was seen with BCT plus USGI of triamcinolone/lidocaine compared with BCT alone: 1: -1.43 (95%CI -0.72, -2.15). Greater mean improvement in pain intensity was seen at 2 weeks (-3.17; -2.28, -4.06) and 2 months (-1.81; -0.92, -2.71), but not at 4 (-0.86; -1.78, 0.05) or 6 months (0.12; -0.80, 1.04). Participants treated with BCT plus USGI of triamcinolone/lidocaine compared with BCT alone had greater mean improvement in function (WOMAC-F -5.47; (-9.41, -1.53)) and pain self-efficacy (5.87; 2.30, 9.45) over 6 months. More participants reported being completely recovered/much better at 2 months with BCT plus USGI triamcinolone/lidocaine than with BCT alone (45.4% v 6.9% RR=6.7; 2.5, 17.9). There was no statistically significant difference over 6 months between BCT plus USGI of triamcinolone/lidocaine compared with BCT plus USGI of lidocaine only for hip pain intensity (-0.52; -1.21, 0.18) or function (-3.60; 7.40, 0.21). There was one treatment-related serious adverse event: a participant with no signs of infection at randomisation died from endocarditis four months after USGI of triamcinolone/lidocaine.

Conclusion: USGI of triamcinolone and lidocaine combined with BCT leads to greater improvements in pain and function over 6 months in adults with hip OA than BCT alone. However, there was no significant difference between the groups receiving USGI of triamcinolone and lidocaine and USGI of lidocaine only raising the possibility of a placebo effect.

Disclosure: Z. Paskins, None; K. Bromley, None; M. Lewis, None; G. Hughes, None; E. Hughes, None; A. Cherrington, None; A. Hall, None; M. Holden, None; R. Oppong, None; K. Stevenson, None; A. Menon, None; P. Roberts, None; G. Peat, None; C. Jinks, None; N. Foster, None; C. Mallen, None; E. Roddy, None.

To cite this abstract in AMA style:

Paskins Z, Bromley K, Lewis M, Hughes G, Hughes E, Cherrington A, Hall A, Holden M, Oppong R, Stevenson K, Menon A, Roberts P, Peat G, Jinks C, Foster N, Mallen C, Roddy E. Clinical Effectiveness of Ultrasound-guided Intra-articular Corticosteroid and Local Anaesthetic Injections for Hip Osteoarthritis: A Randomised Controlled Trial (HIT) [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/clinical-effectiveness-of-ultrasound-guided-intra-articular-corticosteroid-and-local-anaesthetic-injections-for-hip-osteoarthritis-a-randomised-controlled-trial-hit/. Accessed .

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