Of 1,000 patients injected with corticosteroids under fluoroscopic guidance at an academic medical center over a 4½-year period, only 10 experienced serious complications within a year, according to an outcomes review published May 10 in Radiology.
The 1% finding is striking in light of numerous prior studies finding complication rates as high as 15% following such intraarticular corticosteroid (IACS) injections, which are mostly given for relief from osteoarthritis.
The new research was conducted in Switzerland at the University of Zurich and Balgrist University Hospital and is current in Radiology.
Radiologist Dimitri Graf and colleagues analyzed cases of 500 patients injected in the knee and 500 in the hip and followed up with clinical exams as well as imaging (conventional radiography, fluoroscopy, CT or MRI) between 1 and 12 months after injection.
The complications were disrupted blood flow to bone tissue (osteonecrosis, four patients), stress fractures of abnormal bone (insufficiency fractures, three patients) and rapid progressive osteoarthritis (three patients).All complications (six in hips, four in knees) struck between two and nine months after injection.
Interestingly, 54% of the patients were women, but they had 9 of the 10 complications—a finding consistent with previous research.
In their discussion, Graf and co-authors suggest their large sample of 1,000 patients, longitudinal follow-up period of one year and standardized injection procedure “yield potentially more valid results” than earlier and smaller studies. “Our results show that intraarticular steroid injection is substantially safer than smaller studies have reported. However, the strong predominance of complications seen in women needs further evaluation.”
RSNA has posted the study in full for free, along with commentary from radiologist and orthopedic surgeon Jack Jennings, MD, PhD, of Washington University in St. Louis.
Jennings:
Anecdotally, those of us who perform intraarticular corticosteroid (IACS) injections would say these injections help many individuals. However, this anecdotal evidence has not been overwhelmingly demonstrated to date in the literature, and the actual efficacy and durability remain in the balance. The results of the current study are very encouraging regarding the safety profile of IACS. Hopefully, a future randomized control trial with a placebo will answer the critical questions of efficacy, safety and true complications and causation of IACS and enable further evaluation of the preponderance of complications in women that was observed in the current study.”
References:
Dimitri N. Graf, Anne Thallinger, Veronika Zubler, Reto Sutter, “Intraarticular Steroid Injection in Hip and Knee with Fluoroscopic Guidance: Reassessing Safety.” Radiology, online May 10, 2022. DOI: https://doi.org/10.1148/radiol.210668
Jack W. Jennings, “The Safety and Potential Harm of Intraarticular Steroid Injections: The Debate Continues.” Radiology, online May 10, 2022. DOI: https://doi.org/10.1148/radiol.220700
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Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.