Sir, We read with interest the paper by Micu et al. reporting benefit of US-guided steroid injection in their cohort of hip OA patients. We agree with the authors that US guidance is preferable to fluoroscopy guidance, not just from the point of view of practicality, cost and safety, but also US enables detection of synovitis/effu-sion. It has been demonstrated that competence in performing US-guided hip injection can rapidly be achieved by a novice using a flexible training strategy , and this may be an additional reason for rheumatologists to prefer US-guided technique rather than fluoroscopy.The findings of the study are in line with accumulating evidence from recent randomized controlled trials confirming the efficacy of guided steroid injections. The authors seem to imply that benefit of steroid injection is limited to those with US evidence of synovitis/effusion only. Indeed, the presence of synovitis/effusion on US was a prerequisite for entry in their study. However, in our randomized controlled trial of CS injection of the hip of 77 patients with advanced OA, even those without synovitis/effusion (mean measurements of bone to capsule distance of >7mm were defined as indicative of synovitis/effusion) responded to steroid injection .
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