Effect of Intra-articular Ketorolac Versus Corticosteroid Injection for Knee Osteoarthritis: A Retrospective Comparative Study

Abstract

Background: Intra-articular corticosteroid injections have been widely used and are considered a mainstay in the nonoperative treatment of symptomatic knee osteoarthritis (OA). However, their increased use can have negative implications, including chondral toxicity and a high risk of infections. As a result, nonsteroidal anti-inflammatory drugs have been considered as an alternative. Purpose: To determine the pain relief and safety of ketorolac versus a corticosteroid to supplement an intra-articular sodium hyaluronate injection for the treatment of symptomatic knee OA. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 84 patients with unilateral symptomatic knee OA receiving 5 weekly injections were enrolled in this retrospective study. Group A (n = 42) received 3 weekly intra-articular corticosteroid injections (0.5% lidocaine, 25 mg of triamcinolone acetonide, and 25 mg of sodium hyaluronate, followed by 2 weekly injections of 0.5% lidocaine and 25 mg of sodium hyaluronate), while group B (n = 42) received 5 weekly ketorolac injections (0.5% lidocaine, 10 mg of ketorolac, and 25 mg of sodium hyaluronate). The following parameters were used to evaluate pain relief and safety: visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and side effects before the injection and at 1, 2, and 5 weeks after treatment commencement as well as 3 months after the last injection. Results: Patients from both groups had a significant improvement in VAS and WOMAC scores from the first injection to final follow-up at 3 months. In the first week, the VAS score was lower in group A ( P = .041), but no significant between-group differences were found for either the VAS or the WOMAC score at the other time points. Of the 42 patients in group A, 34 (81.0%) and 25 (59.5%) achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. In group B, 32 (76.2%) and 24 (57.1%) patients achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. At final follow-up, no significant difference was found in the successful treatment rate between the groups ( P = .825). Conclusion: The current study demonstrated that intra-articular ketorolac and corticosteroid injections produce the same pain relief and functional improvement.

Comparison of Intraarticular Ketorolac Versus Triamcinolone Acetone Injection in Patients of Knee Osteoarthritis

“…[18][19][20] Jianda et al in a study of 84 patients of knee OA comparing corticosteroids with ketorolac reported similar analgesic and functional outcomes, with a success rate of 59.5% in corticosteroids and 57.1% in the k group. 18 In our study, there was an insignificant difference between the mean WOMAC score at 18 In another study mean VAS scored decreased in both patient groups that either received Ketorolac or Triamcinolone and no statistical difference was found (p-value=0.98). 19 However, patients receiving corticosteroids have a better functional outcome as compared to those receiving NSAIDs.…”

Bedside ultrasound‐guided aspiration and corticosteroid injection of a baker's cyst in a patient with osteoarthritis and recurrent knee pain

“…Use of ketorolac has been studied in knee OA showing similar improvements in pain and knee function compared with triamcinolone, although its efficacy in BCs has not been established. 25 Aspiration and corticosteroid injection of BCs have been previously studied specifically in atraumatic patients with a history of arthritis.…”

Non‐steroidal anti‐inflammatory drugs in equine orthopaedics

“…[90][91][92][93] Studies evaluating the intra-articular administration of ketorolac compared with intra-articular triamcinolone acetonide in human patients with knee OA found similar efficacy and significant improvement in pain scores in both groups. 91,92 Studies evaluating the safety of intra-articular NSAIDs in human and animal models have found mixed results and further research is needed to investigate the effects on cartilage and soft tissue structures. 90,93 In horses, few studies have been performed evaluating the intra-articular use of NSAIDs or sustained drug release products.…”

“…Additional benefits of local administration include the requirement of a lower dose, the ability to use drugs with a low bioavailability, decreased systemic side effects and longer intervals between treatments. In human medicine, intra‐articular administration of ketorolac for treatment of OA and postoperative pain has shown promising results 90‐93 . Studies evaluating the intra‐articular administration of ketorolac compared with intra‐articular triamcinolone acetonide in human patients with knee OA found similar efficacy and significant improvement in pain scores in both groups 91,92 .…”

“…In human medicine, intra‐articular administration of ketorolac for treatment of OA and postoperative pain has shown promising results 90‐93 . Studies evaluating the intra‐articular administration of ketorolac compared with intra‐articular triamcinolone acetonide in human patients with knee OA found similar efficacy and significant improvement in pain scores in both groups 91,92 . Studies evaluating the safety of intra‐articular NSAIDs in human and animal models have found mixed results and further research is needed to investigate the effects on cartilage and soft tissue structures 90,93 …”