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Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis

Matzkin, Elizabeth G. MD; Curry, Emily J. BA; Kong, Qingwu MD; Rogers, Miranda J. MD; Henry, Michael MD; Smith, Eric L. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: October 2017 - Volume 25 - Issue 10 - p 703–714
doi: 10.5435/JAAOS-D-16-00541
Research Article

Introduction: Intra-articular corticosteroid injections are often used for short-term pain relief in patients with knee osteoarthritis (OA). This study investigates the efficacy of intra-articular corticosteroid injections in patients with symptomatic knee OA and factors that affect treatment response.

Methods: This prospective, multicentered cohort study had 100 participants with radiographic evidence of knee OA enrolled. Participants received one corticosteroid injection into the affected knee and were evaluated before the injection (baseline) and at 3 weeks, 6 weeks, 3 months, and 6 months after the injection.

Results: Participants’ Visual Numeric Scale and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores improved at all time points except for the Visual Numeric Scale score at 6 months, compared with baseline scores (P < 0.001). Participants with Kellgren-Lawrence grade 1 or 2 OA saw clinical improvement in the WOMAC scores at all time points, compared with the baseline score (P < 0.01). Compared with all other subgroups, obese patients with Kellgren-Lawrence grade 3 or 4 OA had significantly worse WOMAC scores at baseline, 6 weeks, and 3 months (P < 0.01 and P < 0.01, respectively).

Discussion: Our findings validate previously established guidelines for nonsurgical management of knee OA and suggest that intra-articular corticosteroid injections may be an acceptable short-term management option in patients unwilling or unable to undergo surgical treatment. Obesity and OA severity affect the efficacy of intra-articular corticosteroid injections.

Conclusion: Patients receiving intra-articular corticosteroid injections had improved pain and function. Clinicians should expect less improvement in patients with obesity and/or advanced arthritis. Clinical benefits of intra-articular injections in these patients are less predictable.

From the Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA (Dr. Matzkin), the Department of Orthopaedic Surgery, Boston Medical Center, Boston (Ms. Curry and Dr. Smith), and the Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston (Dr. Kong, Dr. Rogers, and Dr. Henry).

Correspondence to Dr. Smith: eric.smith@bmc.org

Dr. Matzkin or an immediate family member has received research or institutional support from Zimmer Biomet. Dr. Henry or an immediate family member has stock or stock options held in Johnson & Johnson and Teva Pharmaceutical Industries. Dr. Smith or an immediate family member serves as a paid consultant to Arthrocare, DePuy Synthes, and OMNI; serves as an unpaid consultant to OMNI; and has received research or institutional support from ConforMIS, DePuy Synthes, OMNI, Pfizer, and Stryker. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Ms. Curry, Dr. Kong, and Dr. Rogers.

Received July 15, 2016

Accepted February 22, 2017

© 2017 by American Academy of Orthopaedic Surgeons
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