ORIGINAL ARTICLES   Free access

Europa Medicophysica 2000 June;35(2):61-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

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.