Editorial Commentary: When Efficacy is Similar, Risk Should Decide: Why Ketorolac Deserves Priority Over Corticosteroids For Hip Injections.

Abstract

Image-guided hip injections are widely used for osteoarthritis, femoroacetabular impingement syndrome, and extra-articular hip pathology. Corticosteroids have traditionally dominated this space, despite increasing concern regarding joint safety. I argue that injectable nonsteroidal anti-inflammatory drugs, particularly ketorolac, represent a clinically effective and potentially safer alternative to corticosteroids for selected hip conditions. This commentary integrates comparative effectiveness data with recent randomized and observational safety literature, including randomized controlled trial evidence supporting corticosteroid efficacy, to frame a risk-balanced clinical decision model. When symptom relief is comparable, the injectate with fewer catastrophic downside risks should be preferred. Current evidence supports ketorolac as a reasonable and often preferable, first-line option for ultrasound-guided hip injections in appropriately selected patients.