Automated vs. conventional ultrasound-guided intra-articular CS injection for hip pain

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: 1
40 patients with hip pain were randomized to receive an ultrasound-guided intra-articular corticosteroid injection with or without the use of an automated delivery system. The objective of this trial was to determine if the automated delivery was associated with significantly superior clinical efficiency when compared to a traditional injection technique. Outcome measures were Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Industry funded
Sponsor: Carticept Medical
Conflicts: None disclosed
Why was this study needed now?
Due to the deep anatomical nature of intra-articular hip injections, image guidance is often employed to ensure real-time feedback, enhanced needle visualization, and accurate injection placement. Several tools have been developed to enhance the clinical efficiency of ultrasound (US) image guidance, including the drawing and administering of injection fluid through automated systems. Due to the lack of studies comparing traditional US injection methods with automated delivery systems in the administration of intra-articular corticosteroid injections into the hip joint, the current study was warranted.
What was the principal research question?
For patients receiving intra-articular hip joint injections, did administration through ultrasound image guidance with an automated delivery system result ina significant improvement in clinical efficency, pain, hip function, activities of daily living, and sport performance when compared to traditional ultrasound guided injection when assessed over 12 weeks post-treatment?
Population: 40 patients aged 18 years or older with hip pain were included in this study. Patients were required to have failed to respond to at least 3 months of conservative treatment (including physiotherapy, trial of at least one nonsteroidal anti-inflammatory drug) in order to be considered for injection therapy. All patients received one 7 mL injection (2 mL Celestone, 5 mL 1% Lidocaine) through a 22-gauge, 3.5-inch spinal needle with ultrasound image guidance (n=40, 36 completed follow-up).
Intervention: Automated group: patients received an intra-articular injection with the Navigator Delivery System (Carticept Medical Inc., Alpharetta GA) with ultrasound guidance. Injection fluid was administered through a low-flow rate setting and total injection preparation time was recorded during priming time required following selection of "new injection" button (n=20; mean age= 44.1+/-3.43, 12F/8M).
Comparison: Conventional group: patients received an intra-articular injection through standard manual injection techniques with ultrasound guidance. Injection fluid was administered with a constant and gentle pressure and total injection preparation time was recorded between the opening of fluid vials and termination of drawing up of injection fluid (n=20; mean age= 50.6+/-2.48, 8F/12M).
Outcomes: Outcomes of interest included pain via a visual analogue scale (VAS), the modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), and the Hip Outcome score (HOS) which evaluated activities of daily living (ADL) and the Sport-Specific Subscale (SSS). Duration of time required for injection preparation and subjective global assessment (Likert scale) was also recorded.
Methods: RCT: pilot study, prospective, patient-blinded
Time: Outcomes of interest were evaluated at baseline and at 1, 6, and 12 weeks post-treatment.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.