Interested in experiences with steroid injections

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psychopengy

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First of all, I'd like to introduce myself. I'm a 57 year old male living in north Idaho, USA. I also want to thank everyone who contributes to and maintains this site and forum. It's really great.
This might be a long post, so thanks for your patience.
I have OA in both hips. Left hip has been bothering much more of late. No pain as yet in the right hip. I'm considering a TLHR and have already consulted several surgeons. I don't have debilitating pain in my left hip. I can do most activities of daily living with ease (my printer is misbehaving, so I can't print the List of Activities and Abilities Score Sheet). I can even walk for a mile or more with only minor discomfort. But my x-rays show advanced OA, bone spurs on the ball of the femur, and almost bone on bone in one area of the joint. A THR is inevitable. Ideally, I'd like to postpone surgery until early next spring. I work during the fall and winter in a remote location, and if I have the surgery this summer, there probably won't be enough time to recover to be able to go to work. Does anyone know if an intra-articular injection in someone with minimal pain, such as myself, will last a long time, say up to 6 months? Even the surgeons I've consulted say the results are very variable, but any personal experiences would be appreciated. Many thanks.
 

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Welcome to the forum. I'm glad you have found it to be beneficial!

It is my understanding that these injections are not particularly successful....especially for the length of time you are looking to wait until your hip is replaced. But....let me tag Josephine (our forum nurse) to comment, as she is the medical expert.

With hips, things can change quite rapidly and what you want to avoid is an "emergency" situation where the pain suddenly becomes unbearable and you are left waiting for surgery until they can schedule you in. Even without a lot of pain, the fact that you have advanced arthritis in your one hip may cause you some problems if you try to put off surgery for a year.

Is your work extremely physical? Recovery from a THR is 8-12 weeks generally, so I'm not understanding why you couldn't go ahead with the THR and be ready to start work in September or October.
 

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Welcome to BoneSmart, great that you have joined.. I will look forward to hearing Jo's reply :)
 

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Hi psychopengy Welcome to BoneSmart! Jamie is right - things can do downhill very quickly. That was my experience. One minute I could do it all with a bit of irritating aching - then next I was in agony. If your surgeon has already confirm OA, etc. things won't get better I am afraid. Let's wait and see what Jo says.
 

Red Shoe

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Hi psychopengy, I have been having these injection done in a theatre situation for the past three years. Before that I was having steroid jabs in the bursa in clinic. In the first year ( had every six months) my relief was instant. During the second year, I noticed they were taking longer to kick in and the pain relief was not lasting as long. The last one I had was not affective and I realised that my hip must have deteriorated and this was confirmed by my consultant. Good luck with whatever decision you make and Im sure many nice peeps on here will give you some good advice :)
 

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Well, I'm tending to agree with the others. Jaycey and Poppet have both had hip replacements so speak from their experience. I however, have the medical background enough to totally agree with your surgeon. Steroid injections certainly are very variable in effect, in both the degree of effect and how long it lasts. And we have no idea which way it's going to affect any individual. Best you can do is try it and see.

I will say that injections into the hip are usually more complicated than with any other joint because they have to be done under xray control, being the only way the surgeon can tell exactly where his needle is! However, that's done under a local anaesthetic and you would be able to get up off the table and go straight home so no problems there.

As for your xrays, they only show part of the issue. The other part is your experience. I've seen xrays that were and yet the patient was perfectly mobile and insisted they had only moderate pain while with other xrays what showed only minimal damage, the patient was practically in a wheelchair! Last October my surgeon declared my left knee to be bone-on-bone and was ready to be done straight away. But now, seven months later, I'm still in the 'only niggly pain' category and have no need of pain meds. So I am still waiting for that 'when it's ready you will know' moment. The way things are going it might be late in the year, could even be next year. Who knows? Moral of the story being it's entirely up to you and your own concept of what is acceptable pain/disability. The check list should help you answer that question. I do suggest that perhaps you put it on a memory stick and get someone else to print it off for you. It's that good a tool to help you decide. And while you're at it, print off two or three copies and complete one very 2-3 months so you can plot how things progress.
 
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Thank you everyone for your replies. So many variables and unknowns. This is the toughest decision I've ever had to make. The decision as to whether to have THR or not is difficult enough, but how it will affect my ability to return to work is equally frightening. I managed to print the Activities and Abilities chart and will fill it out. I'm sure to have more questions later. Best to you all.
 

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Honestly, we all fully understand and sympathise. Come back often - we're always here and we love questions! :yes:
 

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psychopengy, I've had cortisone injections for my knees, and they've been helpful (usually for about 3-4 months). I've had a couple of injections for my hip bursa, and they've given immediate relief, but because the underlying problem wasn't solved, the pain came back. One surgeon I spoke to (not the one I'll be using for my RTHR) wouldn't consider giving me a hip injection. He said he'd have to do it in hospital, using the x-ray, and it is something he only does on an emergency basis while awaiting hip surgery, not something he'd do more than once. The OS I've gone to for several years (who does general and sports OS, and is a foot specialist and dance medicine specialist, but doesn't do hips) was willing to do a hip injection, and could have done it in his office, using ultrasound, but the injection in my bursa was all that was needed. The sense I've gotten from the doctors I've spoken with is that they don't like to do the hip injections, by and large. They seem to feel that if you qualify for a hip replacement, and are having that much pain, it's time to do the surgery, and not do the injection.
 

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The sense I've gotten from the doctors I've spoken with is that they don't like to do the hip injections, by and large.
Whilst not wishing to scare the bejeebers out of you all, the real reason why this is such a big issue for these chaps and why it's necessary - and very, very wise - to use either xray control or ultrasound is the closeness of structures like the arteries and veins.
Hip injections and why they need to be done in hospital.
 

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I really didn't want to do anything too invasive as I wait out the time till I can have surgery (only 8 weeks now!), but in the late winter everything hurt too much to really sleep well or be comfortable in most tasks, so I got a shot in late Feb. It helped instantly - I got up off the table and walked to my car and felt better than I'd felt in six months. That lasted about 5 weeks, one day I moved a bunch of furniture around and ran up and down stairs carrying dresser drawers and that was the end of that... There are restrictions on the shots, you can only have one every three months and depending upon your own situation your doctor will tell you how close you can have one to surgery. I had one Friday, because the 8 week mark was as late as I could go. It helped, but not as much as the first time. I have heard that over time they hasten the decay of the remaining cartilage, but if you don't have any left then don't worry about that. :) I had to take the last step last month and go on tramadol so I could sleep nights. I figure in the last few months before surgery my priority is to get through intact without getting too run-down.
As to the shot itself - the doctor who did mine was REALLY GOOD, it did hurt but only for about 8 seconds. Some people say it hurts a whole lot, and others say it was no big deal, I fell more in the NBD category. I suppose a factor might be how deep they have to go - I am fairly thin so there was not as much depth to puncture as if someone was more heavily padded on the front of the top of the thigh...
 

iteldoo4me

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First injection in my left hip,think prior to this and suffering disability for over a year,it was a case of the thought of the pain was worse than the actual procedure.From time scale to time scale it is so variant from different people,and also depended on how far the condition has progressed,I also had immediate relief,a little achy for the day,but next day(today) i am pleasantly refreshed,a great night sleep,and was raring to go this morning,and what a pleasure to be 'pain free' optimistically stated,yet for some its a few days,others longer.I CERTAINLY WONT BE SO PUMPED UP NEXT TIME I GO,AS SURE I WILL HAVE TO,TILL THEN THE QUALITY OF LIFE HAS IMPROVED.great site,and glad I have come to learn more of my condition through others.

I am male,65,osteoarthritis for 2 years,no real help from my docs in nottingham,palmed me off with soluble pain killers(US)..then moved to derby 8 months ago,and attention,concern,treatment,help,has been amazing,shows some health authorities are more concientious than others.!
 
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iteldoo4me, have edited the post above. It is not necessary to use the "Quote This Message" to reply to a post. This feature should be used only when there is a post or several posts on another topic between your post and the post you want to respond to.

To reply to a post, just put your cursor in the dialogue box and start typing.

You can quote a sentence or a section of a post by simply highlighting it and clicking on the "Quote Me" oblong that appears in gray at the end of the highlighted selection. This is frequently a better choice than quoting a whole post.

Please do not be upset by this bit of info---many new members have this very same problem---so you're in very good company---and we're not mad at you---just trying to keep the forum neat and tidy.
 

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Psychopengy, you don't mention whether you have tried any pain meds for your OA....either OTC or prescription. I was like you for a fairly long time....things were slowly getting worse, but my xrays were awful. I was able to stall for about 18 months once I settled on Celebrex for pain. I did try otc nsaids first, but they upset my stomach terribly.

Once I was fully bone on bone though, even the celebrex wasn't much help. That was when I said...it's time. But even then, it was five months before I had the surgery. Those months were painful, and I limped something fierce, but I managed. Good luck whatever you decide. Let us know.

Sharon
 
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Thanks for the responses. I just finished a 2 week course of generic ibuprofen, 200mg, 3x/day. I think it helped a little, but I don't like taking that stuff long term. It doesn't upset my stomach at all, but I've heard it can have a negative effect on your liver (or kidneys, or both - can't remember which. Can the nurses on the forum educate me about which NSAIDS affect which organs? Thanks.). One surgeon I consulted with (I've seen 5!), said I could try management with NSAIDS for several months, but that would require some kind of kidney ultrasound or liver function test periodically. That's unavailable where I work and I probably wouldn't be allowed to go anyway if I would need such testing. Maybe Celebrex would be an option.
 

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Welcome psychopengy, I believe this is the first time I have visited your thread. I have provided a link to a library reticle regarding medications that you may find useful.

http://bonesmart.org/forum/threads/...e-naproxen-advil-ibuprofen-and-tylenol.12858/

If you want additional information here is a tip, if you want to "tag" someone in response to their messages to you just type in the @ sign immediately followed by their user name and you'll see a small box below and to the left of the posting area where the members user name will display. Sometimes there might be a very slight pause, but the member user name will appear.

it will show their correct name which you can click on -- then when you submit your post the member's user name/link will turn blue and send a message to them person, like this

Poppet
 
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psychopengy

psychopengy

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Poppet Thanks for the information. Maybe I need to ask Josphine this, but I'm still a little confused. In the first paragraph of her explanation, she states that Advil is ibuprofen and Aleve is naproxen, yet just below that paragraph she writes "Both Advil and Aleve are ibuprofen and therefore NSAIDs". Am I correct in understanding that ibuprofen (Advil, Motron, Nuprin) and naproxen (Aleve, Naprosyn) are NSAIDs, but that Tylenol, paracetamol, acetaminophen are not? Tylenol/paracetamol/cetaminophen are not listed in her second post in the list of NSAIDs. Thanks.
 

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You are correct: acetaminophen is NOT an Nsaid. Ibuprofen and naproxen are both Nsaids. Both can cause kidney/liver problems in the long term.

When I did a two week therapeutic course of ibuprofen, I took 600mg 3x a day. My doctor told me to do that for two weeks. I had FULL relief from pain by the third day. But by the end of a week, I also had awful gastric issues. I tried cutting down, rather than out, but gave up completely after two more days. The stomach bloat and indigestion were more debilitating than the OA pain. This is how it affected me and does not predict anything for anyone else.

Celebrex is supposed to have fewer gastric side effects and for me that's been true. I get none. Hurray. A major deciding factor for me was to have the THR in order to avoid medications altogether. I currently put up with some pain in order to stay drug free. I do occasionally take meds when I have to be fully functional. I am doing some extended travelling soon and my celebrex will go with me. I anticipate having to take it at least every other day if I want to get full enjoyment from my trip. It's a trade-off. But as soon as I'm back home, I'll stop using it again. (Celebrex is also considerably more expensive than OTC drugs. Wish it would become a generic already!!) When I was on Celebrex for an extended period, my doctor wanted me to have blood tests for liver function once a year.

So....let's sum it all up:
1. NO drug is completely safe. Tylenol is probably the mildest/safest. You can have up to 4000mg in a 24 hour period (making sure that's the TOTAL amount from all sources; watch out for cold medications). That could give you very good pain relief.
2. Jo often suggests a tylenol/ibuprofen combo: http://bonesmart.org/forum/threads/medications-tylenol-ibuprofen-cocktail.12217/
3. No drug is completely safe.
4. You want to delay surgery till next spring. You don't really want to take meds. (I totally understand.) You are currently managing with not too much pain.
5. Injections may or may not help. No way to know unless you try.
6. Things might stay the same. Things might get worse. Things might get a lot worse. Only thing we know for sure is that it won't get better.
7. Your xrays are depressing.

How about this? You stick with the status quo, since you're managing pretty well doing nothing. You get on the schedule for an early spring surgery so at least you know it's set if you need it. Discuss with your doctor the notion of taking over the counter meds with your as a fall-back in case there are episodes of extra pain. Just a thought.

Sharon
 

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psychopengy, my 2 cents worth, I had injection into the hip joint under ultrasound. Pain decreased first 3 days and then worse than ever, inflammation was down (felt less stiff) but bone pain was maddening! So for me it did not work. Good luck :)
 

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she states that Advil is ibuprofen and Aleve is naproxen, yet just below that paragraph she writes "Both Advil and Aleve are ibuprofen and therefore NSAIDs".
psycho, thank you so much for bringing that error to my attention. I have corrected it.
Am I correct in understanding that ibuprofen (Advil, Motron, Nuprin) and naproxen (Aleve, Naprosyn) are NSAIDs, but that Tylenol, (paracetamol, acetaminophen) are not?
You are completely correct and this is the reason that Tylenol is not in the list of NSAIDs.
 
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