What is the recommended limit for hip bursa injections in a 12-month period?

From the Guidelines

The recommended limit for hip bursa injections in a 12-month period is 3-4 injections per year. This limitation is based on the general accepted rule, though not backed by research evidence, to avoid overuse of corticosteroid injections in the same joint [ 1 ]. The European League Against Rheumatism (EULAR) recommendations for intra-articular therapies suggest that the shared decision to reinject a joint should take into consideration benefits from previous injections and other individualized factors [ 1 ].

Key Considerations

• The frequency of injections should be determined on a case-by-case basis, considering the patient's response to previous injections, treatment options, and comorbidities [ 1 ].
• Corticosteroid injections can lead to tissue damage, weakening of tendons and ligaments, cartilage deterioration, and systemic side effects if absorbed into the bloodstream [ 1 ].
• Patients should be advised to avoid overuse of the injected joint for 24 hours following the injection, but immobilization is discouraged [ 1 ].

Alternative Treatments

• Physical therapy, activity modification, and weight management may be considered as alternative treatments for patients who require frequent injections [ 1 ].
• Surgical intervention may be necessary for persistent cases of bursitis that do not respond to conservative treatments [ 1 ].

Important Notes

• The EULAR recommendations emphasize the importance of aseptic technique when performing intra-articular therapies to minimize the risk of septic arthritis [ 1 ].
• Patients with diabetes should be informed about the risk of transient increased glycaemia following intra-articular glucocorticoid injection and advised to monitor their glucose levels [ 1 ].

From the Research

Hip Bursa Injection Limit

The recommended limit for hip bursa injections in a 12-month period is not explicitly stated in the provided studies. However, some studies provide information on the frequency and dosage of corticosteroid injections for hip bursitis and other conditions.

• The study 2 found that 11 out of 25 hips (45%) required multiple injections for postarthroplasty trochanteric bursitis, but it does not specify a recommended limit for injections in a 12-month period.
• The study 3 reports on the practice patterns of sports medicine physicians for large joint and bursa injections, including the hip. It notes that most respondents used 21 to 40 mg of corticosteroid for all injections, but it does not provide information on the recommended frequency of injections.
• The study 4 found that 8 out of 19 patients (30%) required a second injection for iliopsoas tendonitis after total hip arthroplasty, at an average of 8.2 months after the first injection. However, it does not specify a recommended limit for injections in a 12-month period.

Key Findings

• There is no clear consensus on the recommended limit for hip bursa injections in a 12-month period.
• Multiple injections may be necessary for some patients, depending on the condition being treated and the individual response to treatment.
• The dosage and frequency of corticosteroid injections should be determined on a case-by-case basis, taking into account the patient's medical history, condition, and response to treatment, as noted in studies 2, 3, and 4.

Injection Frequency and Dosage

• The study 3 found that most respondents used 21 to 40 mg of corticosteroid for all injections, but some used higher doses (>40 mg) for at least one injection type.
• The study 5 highlights the importance of radiological confirmation of bursal spread to ensure that the injectate reaches the area of pathology during trochanteric bursa injections.