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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
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Europa Medicophysica 2000 June;35(2):61-6

language: English

Value of hip anesthesia to characterize the main origin of pain in hip-spine osteoarthritis

Poiraudeau S. 1, Martinez M. 1, Anract P. 2, Chevrot A. 3, Revel M. 1

1 Hôpital Cochin, Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Université René Descartes, Paris;
2 Service d’Orthopédie B, Paris;
3 Service de Radiologie


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BACKGROUND: To eval­u­ate the val­ue of lid­o­caine hip injec­tion to deter­mine the ­main ori­gin of ­pain in ­patients ­with clin­i­cal and radio­log­i­cal evi­dence of hip and ­spine oste­oar­thritis.
METHODS: Retrospective ­study ­with a ­mean fol­low-up of 28 ­months. Ambulatory ­care ­patients ­were ­referred to the depart­ment for injec­tion of ten mil­li­li­ters of 2% lid­o­caine ­into the hip ­joint ­under flu­o­ro­scop­ic con­trol. During the ­same pro­ce­dure, 1.5ml (3.75 mg) of cor­tiv­a­zol ­could ­also be inject­ed accord­ing to the rec­om­men­da­tions of the ­patient’s phy­si­cian. The hip was con­sid­ered as the ­main ori­gin of ­pain ­when 20 to 30 min­utes ­after the intra­ar­tic­u­lar injec­tion, the ­patient not­ed a ­decrease of at ­least 75% of his usu­al symp­toms. Corticoid hip injec­tion or ­total hip arthro­plas­ty ­results ­were eval­u­at­ed at ­least 6 ­months ­after treat­ment by a ­mailed ques­tion­naire on a 5-lev­el ­semi-quan­ti­ta­tive ­scale (0 = ­null, 1 = ­poor, 2 = ­fair, 3 = ­good, 4 = excel­lent).
RESULTS: Ninety ­patients ­were eval­u­at­ed. The ­test was pos­i­tive in 44 ­patients. Twenty of ­these 44 ­patients under­went ­total hip arthro­plas­ty (THA), 18 ­with excel­lent ­results. A cor­ti­cos­ter­oid hip injec­tion was admin­is­tered to 26 pos­i­tive ­test ­patients and 17 had excel­lent or ­good ­results. Nine ­patients ­with a neg­a­tive ­test under­went THA; ­only 5 had excel­lent or ­good ­results. A cor­ti­cos­ter­oid hip injec­tion was admin­is­tered in 24 neg­a­tive ­test ­patients; ­only one had ­good ­results. For THA, the ­test had a sen­si­tiv­ity of 0.78 and a spec­i­fic­ity of 0.67, a pos­i­tive pre­dic­tive val­ue of 0.90 and a neg­a­tive pre­dic­tive val­ue of 0.45, ­with an effi­cien­cy of 0.76. For cor­ti­cos­ter­oid injec­tion, the ­test had a sen­si­tiv­ity of 0.94 and a spec­i­fic­ity of 0.71, a pos­i­tive pre­dic­tive val­ue of 0.65 and a neg­a­tive pre­dic­tive val­ue of 0.96, ­with an effi­cien­cy of 0.80.
CONCLUSIONS: Lidocaine hip injec­tion ­appears to be a use­ful ­tool to deter­mine the ori­gin of ­pain in ­patients ­with hip and ­spine oste­oar­thritis and to pre­dict the out­come of THA and cor­ti­coid hip injec­tion.

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