Experiences of living with hip osteoarthritis and of receiving advice, education and ultrasound-guided intra-articular hip injection in the hip injection trial: A qualitative study

Objectives: The Hip Injection Trial (HIT) compared the effectiveness of adding a single ultrasound-guided intra-articular injection of either corticosteroid and local anaesthetic, or local anaesthetic alone, to advice and education among people with hip osteoarthritis (OA). This nested qualitative study explored participants’ experiences of living with hip OA and of the trial treatment they received.

Method: Semi-structured telephone interviews were undertaken with a purposeful sample of trial participants after 2-month trial follow-up. Interviewers were blind to which injection participants had received. Thematic analysis using constant comparison was undertaken prior to knowing trial results.

Results: 34 trial participants were interviewed across all arms. OA caused pain, physical limitations, difficulties at work, lowered mood, and disrupted sleep. Those who received advice and education alone felt that they had not received ‘treatment’ and described little/no benefit. Participants in both injection groups described marked improvements in pain, physical function, and other aspects of life (e.g., sleep, confidence). Perceived magnitude of benefit appeared greater among those who received the corticosteroid injection, however length of benefit varied in both injection groups. There was uncertainty about the longer-term benefits of injection and repeated injections.

Conclusion: Hip OA is highly burdensome. Participants perceived little/no benefit from advice and education alone but reported marked improvements when combined with either injection. However, the magnitude of benefit was greater among those who received corticosteroid. Varying duration of response to injection and uncertainty regarding longer-term benefits of injection and repeated injections suggest these areas are important for future research.