Value of intraarticular injections with local anesthetics in hip-spine syndrome patients while choosing the surgery

Objective: to determine the value of intraarticular injections with local anesthetics while choosing the first surgery in patients with hip-spine syndrome. Materials and methods. This is a prospective study, 45 patients with hip-spine syndrome and difficulties in choosing the right surgery were included. For all patients we performed ultrasound-guided intraaticular injections with ropivocaini 7,5 mg – 3,0, needle EMG, thorough clinical examination. All the patients were divided into two groups, where THA and spinal surgeries were performed. Patient`s status before and after surgeries was evaluated basing on VAS, Harris and Oswesrty scores. Results. Sensitivity and specificity of intraarticular injections for determining “what surgery to perform begin with”, based on VAS decreasing 40 mm and more, resulted as 91% and 69% with positive predictive value 67%. We see pain reduction after injection in patients that needed THA either as the only surgery or as a second stage after lumbar spine stenosis decompression. Discussion. Gained sensitivity (91%) is comparable to those described in other reviews and publications. But such low specificity (69%) and positive predictive value (67%) were never explained before because no one used any alternative method to decide the right surgery in patients with hip-spine syndrome. Conclusion. Pain reduction after the injection (VAS 40 mm decreasing and more) shows that such patient will need a THA, but if there are sings of denervation due to needle EMG spinal surgery should be performed first.