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A Randomized Trial of Intra-articular Injection Therapy for Knee Osteoarthritis

Intra-articular injections are widely used for conservative treatment of knee osteoarthritis (OA). However, rigorous data are lacking regarding the comparative therapeutic effectiveness of these injections. PURPOSE: The aim of this study was to compare clinical outcomes after intra-articular injecti...

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Autores principales: Tschopp, Marcel, Pfirrmann, Christian W.A., Fucentese, Sandro F., Brunner, Florian, Catanzaro, Sabrina, Kühne, Nathalie, Zwyssig, Iwan, Sutter, Reto, Götschi, Tobias, Tanadini, Matteo, Rosskopf, Andrea B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10090303/
https://www.ncbi.nlm.nih.gov/pubmed/36728848
http://dx.doi.org/10.1097/RLI.0000000000000942
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author Tschopp, Marcel
Pfirrmann, Christian W.A.
Fucentese, Sandro F.
Brunner, Florian
Catanzaro, Sabrina
Kühne, Nathalie
Zwyssig, Iwan
Sutter, Reto
Götschi, Tobias
Tanadini, Matteo
Rosskopf, Andrea B.
author_facet Tschopp, Marcel
Pfirrmann, Christian W.A.
Fucentese, Sandro F.
Brunner, Florian
Catanzaro, Sabrina
Kühne, Nathalie
Zwyssig, Iwan
Sutter, Reto
Götschi, Tobias
Tanadini, Matteo
Rosskopf, Andrea B.
author_sort Tschopp, Marcel
collection PubMed
description Intra-articular injections are widely used for conservative treatment of knee osteoarthritis (OA). However, rigorous data are lacking regarding the comparative therapeutic effectiveness of these injections. PURPOSE: The aim of this study was to compare clinical outcomes after intra-articular injections of glucocorticoid, hyaluronic acid, platelet-rich plasma (PRP), or placebo in patients with mild or moderate OA of the knee. MATERIALS AND METHODS: In a double-blinded, placebo-controlled, single-center trial, we randomly assigned knees with early- to middle-stage knee OA (Kellgren-Lawrence grade 1–3) to an intra-articular injection with one of these substances: glucocorticoid, hyaluronic acid, PRP, or placebo. Primary outcome was pain reduction within 6 months after the injection, assessed with the numeric rating scale (NRS; range, 0–100). Secondary outcome parameters included WOMAC scores, Tegner Activity Scale, knee mobility, and adverse events. Finally, a linear mixed-effects model was calculated and corrected for possible patient and covariate effects. RESULTS: One hundred twenty knees (30 knees per treatment group) in 95 patients (41 female) were included in the final analysis. The median age of patients was 60 years (interquartile range, 54.0–68.0). There was no evidence that the drug effects of primary and secondary outcome parameters differed over time. The median pain at baseline was 32.5 (interquartile range, 15.00–50.00) on NRS. The changes in pain level during the first 6 months compared with baseline were small (within ±5 points on NRS), whereas the intrapatient variability was large between −20 and +20 points. Secondary outcome parameters did not differ significantly among the groups. Kellgren-Lawrence grade did not have a statistically significant effect on pain reduction (P = 0.61). CONCLUSIONS: There is no evidence that knee injections with glucocorticoid, PRP, or hyaluronic acid have superior short- or long-term effects in patients with low pain level at baseline and early- to middle-stage knee OA when compared with placebo.
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spelling pubmed-100903032023-04-13 A Randomized Trial of Intra-articular Injection Therapy for Knee Osteoarthritis Tschopp, Marcel Pfirrmann, Christian W.A. Fucentese, Sandro F. Brunner, Florian Catanzaro, Sabrina Kühne, Nathalie Zwyssig, Iwan Sutter, Reto Götschi, Tobias Tanadini, Matteo Rosskopf, Andrea B. Invest Radiol Original Article Intra-articular injections are widely used for conservative treatment of knee osteoarthritis (OA). However, rigorous data are lacking regarding the comparative therapeutic effectiveness of these injections. PURPOSE: The aim of this study was to compare clinical outcomes after intra-articular injections of glucocorticoid, hyaluronic acid, platelet-rich plasma (PRP), or placebo in patients with mild or moderate OA of the knee. MATERIALS AND METHODS: In a double-blinded, placebo-controlled, single-center trial, we randomly assigned knees with early- to middle-stage knee OA (Kellgren-Lawrence grade 1–3) to an intra-articular injection with one of these substances: glucocorticoid, hyaluronic acid, PRP, or placebo. Primary outcome was pain reduction within 6 months after the injection, assessed with the numeric rating scale (NRS; range, 0–100). Secondary outcome parameters included WOMAC scores, Tegner Activity Scale, knee mobility, and adverse events. Finally, a linear mixed-effects model was calculated and corrected for possible patient and covariate effects. RESULTS: One hundred twenty knees (30 knees per treatment group) in 95 patients (41 female) were included in the final analysis. The median age of patients was 60 years (interquartile range, 54.0–68.0). There was no evidence that the drug effects of primary and secondary outcome parameters differed over time. The median pain at baseline was 32.5 (interquartile range, 15.00–50.00) on NRS. The changes in pain level during the first 6 months compared with baseline were small (within ±5 points on NRS), whereas the intrapatient variability was large between −20 and +20 points. Secondary outcome parameters did not differ significantly among the groups. Kellgren-Lawrence grade did not have a statistically significant effect on pain reduction (P = 0.61). CONCLUSIONS: There is no evidence that knee injections with glucocorticoid, PRP, or hyaluronic acid have superior short- or long-term effects in patients with low pain level at baseline and early- to middle-stage knee OA when compared with placebo. Lippincott Williams & Wilkins 2023-05 2022-12-27 /pmc/articles/PMC10090303/ /pubmed/36728848 http://dx.doi.org/10.1097/RLI.0000000000000942 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Article
Tschopp, Marcel
Pfirrmann, Christian W.A.
Fucentese, Sandro F.
Brunner, Florian
Catanzaro, Sabrina
Kühne, Nathalie
Zwyssig, Iwan
Sutter, Reto
Götschi, Tobias
Tanadini, Matteo
Rosskopf, Andrea B.
A Randomized Trial of Intra-articular Injection Therapy for Knee Osteoarthritis
title A Randomized Trial of Intra-articular Injection Therapy for Knee Osteoarthritis
title_full A Randomized Trial of Intra-articular Injection Therapy for Knee Osteoarthritis
title_fullStr A Randomized Trial of Intra-articular Injection Therapy for Knee Osteoarthritis
title_full_unstemmed A Randomized Trial of Intra-articular Injection Therapy for Knee Osteoarthritis
title_short A Randomized Trial of Intra-articular Injection Therapy for Knee Osteoarthritis
title_sort randomized trial of intra-articular injection therapy for knee osteoarthritis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10090303/
https://www.ncbi.nlm.nih.gov/pubmed/36728848
http://dx.doi.org/10.1097/RLI.0000000000000942
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