Ultrasound-Guided Hip Injections for Osteoarthritis, Femoroacetabular Impingement Syndrome, and Extra-articular Pathology With Ketorolac Provide Greater Pain Relief and Similar Duration of Action Compared With Corticosteroids.

Abstract

To compare patient outcomes following ultrasound-guided nonsteroidal anti-inflammatory drug injections (NSI) versus corticosteroid injections (CSI) for osteoarthritis (OA), femoroacetabular impingement syndrome (FAIS), and extra-articular tendinopathy (ET) of the hip. A retrospective analysis of a single-institutional database of patients undergoing ultrasound-guided injections for hip pathology with NSI (ketorolac) and CSI (dexamethasone) between October 2022 and November 2024 was performed. Patients were separated into 3 groups based on hip pathology: OA, FAIS, and ET. Exclusion criteria included avascular necrosis, fracture, inflammatory arthritis, a history of prior hip injections, and patients with less than 6 months of follow-up or incomplete follow-up. Outcomes including pre-injection pain scores, post-injection pain scores, patient-reported improvement, effect onset, effect duration, and side effects were analyzed. Ninety hips from 89 patients were included with minimum 6-month follow-up (mean 14.2 ± 6.7 months). No significant demographic differences existed between NSI (n = 45) and CSI (n = 45) groups. FAIS patients were younger than patients with other hip pathologies (42.6 years FAIS, 50.8 ET, 58.8 OA, P < .01). On multivariate analysis, NSI was correlated with a significantly greater decrease in pain score after injection when compared with CSI (P = .035). There was no difference in pain relief based on hip pathology, but female patients were more likely to show improvement compared with male patients. In patients with reported pain relief from injections, there was no significant difference in overall reported percentage improvement (47% ± 33% NSI, 39% ± 35% CSI, P = .33), duration of effect (93 d ± 124 d NSI, 128 d ± 165 d steroid, P = .35), or effect onset time (3.3 d ± 4.6 d NSI, 11.1 d ± 33.8 d CSI, P = .22). Ultrasound-guided injections for hip OA, FAIS, and ET with ketorolac may provide greater pain relief with a similar duration of action compared with corticosteroids. Level III, therapeutic retrospective comparative matched case series.