Intra-Articular Corticosteroid Injections for Symptomatic Knee Osteoarthritis

What the Orthopaedic Provider Needs to Know

Cody L. Martin, MD; James A. Browne, MD

Disclosures

J Am Acad Orthop Surg. 2019;27(17):e758-e766. 

In This Article

Abstract and Introduction

Abstract

Intra-articular corticosteroid injections have been used for decades in the management of symptomatic osteoarthritis of the knee and remain a common practice. The pain relief from a steroid injection is thought to work by reducing inflammation within the arthritic knee. Substantial variability remains among providers with regard to the technique used to perform the procedure, including the site of the injection, the medications injected, and the level of sterility. The success of steroid injections in relieving arthritic knee pain most often occurs in the short term. However, the efficacy of intra-articular corticosteroid injections varies within the published literature. The latest American Academy of Orthopaedic Surgeons clinical practice guideline does not support conclusive recommendations about the use of intra-articular corticosteroid injections for symptomatic knee osteoarthritis. Providers should be aware of the adverse effects and potential complications of these injections when using them in clinical practice.

Introduction

Osteoarthritis is the leading cause of disability in adults and affects an estimated 52.5 million adults in America.[1] The knee is one of the most common locations of this disease and is the most disabling, accounting for 83% of the total disability burden of osteoarthritis.[2] Its prevalence has doubled in the modern postindustrial era.[3] No known cure exists for osteoarthritis. Standard treatments, including intra-articular steroid injections, focus on symptomatic relief. Intra-articular steroid injections are thought to work by reducing inflammation within the joint and synovium, although the exact mechanism is not known.[4–6] Indications for their use are short-term symptomatic relief of osteoarthritis after failure of other nonsurgical measures.

The Osteoarthritis Research Society International group published an update of evidence-based, consensus recommendations on knee osteoarthritis in 2014 in which they recommended that intra-articular steroid injections are appropriate for patients with knee and multijoint osteoarthritis with or without comorbidities for short-term pain relief.[7] The American Academy of Orthopaedic Surgeons, on the other hand, was unable to support conclusive recommendations concerning the use of intra-articular corticosteroids for patients with symptomatic osteoarthritis of the knee.[8] The work group found limited high-quality clinical data with only four placebo comparison studies meeting their criteria, with the findings revealing conflicting results.[8] Although strong data are lacking, the use of intra-articular corticosteroid injections for the management of knee osteoarthritis has remained commonplace.

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