The Efficacy and Duration of Intra-articular Corticosteroid Injection for Knee Osteoarthritis: A Systematic Review of Level I Studies

Hepper, Clifford Tate; Halvorson, Jason J.; Duncan, Stephen T.; Gregory, Andrew M.; Dunn, Warren R.; Spindler, Kurt P.

doi:10.5435/00124635-200910000-00006

Cited by 196 publications

(120 citation statements)

References 21 publications

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“…It would bring complexity and the necessity of a longer followup. We observed improvement in all patients, but the VAS and WOMAC TM scores decreased to lower levels and sooner in Group VS + T. This phenomenon can be explained by the faster pain relief and function improvement for intraarticular corticosteroid injections [4,6,15]. The charts (Fig.…”

Section: Discussionmentioning

confidence: 89%

“…The regimen adopted for this study was a single injection of 6 mL of hylan GF-20, which is accepted only for this particular product [8]. Fifth, there was concern regarding the chondrotoxicity of intraarticular corticosteroid injections [24], but after a review of the literature [6,15] we concluded there was enough safety evidence on this matter. One 2-year followup randomized clinical trial showed no loss of joint space width after the intraarticular injection of triamcinolone hexacetonide at 3-month intervals [26].…”

Section: Discussionmentioning

confidence: 99%

“…Third, we had no saline injection placebo group. Several studies [3,7,8,11,22] have compared viscosupplementation versus placebo and intraarticular corticosteroid versus placebo [6,15,26] (Table 5). We also were able to have a control group that received treatment (VS), conducting a study without the ethical issues of using a placebo group.…”

Section: Discussionmentioning

confidence: 99%

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Adding Triamcinolone Improves Viscosupplementation: A Randomized Clinical Trial

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Pailo

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Adding Triamcinolone Improves Viscosupplementation: A Randomized Clinical Trial

Campos

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Pailo

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Clinical studies generally show corticosteroids help control short-term pain in patients with degenerative joints [3,13,21,26]. Triamcinolone, a commonly used intraarticular corticosteroid [8,42], is clinically nondeleterious [37].…”

Section: Introductionmentioning

confidence: 99%

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

Syed¹,

Green²,

Bianski³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Intraarticular injections of corticosteroids combined with local anesthetics are commonly used for management of chronic pain symptoms associated with degenerative joint diseases and after arthroscopic procedures. Several studies suggest chondrotoxicity of local anesthetics whereas others report chondroprotective and cytotoxic effects of corticosteroids on cartilage. Given the frequency of use of these agents, it is important to know whether they are in fact toxic. Questions/purposes We asked whether (1) bupivacaine and triamcinolone acetonide, alone and combined, were chondrotoxic to chondrocytes in culture; (2) buffering of the reagents diminished toxicity of the bupivacaine and triamcinolone; and (3) the presence of the superficial layer of articular cartilage protects against toxicity. Materials and Methods We obtained cartilage from three patients undergoing arthroplasty. To address triamcinolone acetonide, bupivacaine, and combinatorial toxicity to human chondrocytes, we set up monolayer chondrocyte cultures (n = 8 wells per condition). The question of buffering was addressed by performing the same assays as above, but the reagents were buffered. An MTT assay was used to assess chondrocyte survival in the monolayer. We harvested 21 articular plugs from each of three patients (total 63 plugs) and exposed them to the same reagents as above, including the buffered reagents. A Live/Dead assay was used to determine chondrocyte survival. Results Triamcinolone acetonide, bupivacaine, and their combination were toxic to human chondrocytes in the monolayer comparisons. The addition of buffering did not mitigate chondrocyte death. With the intact superficial layer in the plug group, bupivacaine was not toxic as compared with for the control group; all the other reagents (triamcinolone, combination bupivacaine/triamcinolone, buffered bupivacaine, buffered triamcinolone, and buffered combination) produced chondrotoxicity. Conclusions Triamcinolone induced chondrotoxicity in the articular plug and monolayer culture, whereas bupivacaine induced chondrotoxicity only in monolayer culture. The combined used of triamcinolone and bupivacaine did not show additive chondrocyte death in any arm. Buffering of bupivacaine increased its chondrotoxicity. Clinical Relevance Although not necessarily reflecting in vivo conditions, our data suggest physicians should be cognizant of the potential in vitro chondrotoxicity of bupivacaine and triamcinolone when contemplating intraarticular administration.

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“…Biologic responses to ultrasound therapy via thermal and non-thermal effects include increased pain threshold, tissue regeneration, muscular relaxation and decrease in inflammation (5,6). The use of intraarticular glucocorticoid injection can be helpful in relieving pain and improving function in patients (7). This class of drugs acts by inhibiting cartilage catabolism and preventing the formation of osteophytes (8).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Efficacy of Dexamethasone Phonophoresis on Symptomatic Knee Osteoarthritis in Elderly Women

Toopchizadeh¹,

Javadi²,

Sadat³

2014

IJWHR

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Objectives: The knee joint osteoarthritis is one of the important causes of disability and is more frequent in menopausal women. Phonophoresis is a therapeutic method using ultrasound to enhance percutaneous absorption of drugs. This study was aimed at evaluating the therapeutic efficacy of dexamethasone phonophoresis in the management of knee osteoarthritis in elderly women. Materials and Methods: 55 women aged 56.03±5.7 years who had mild or moderate knee osteoarthritis were randomly allocated into 3 groups. First group (n=18) received ultrasound (as control group), second group (n=18) received phonophoresis of 4mg dexamethasone ampoule and third group (n=19) received phonophoresis of 0.4% dexamethason gel. All groups were treated with an ultrasound program using stroking technique, pulse mode, 1.5 W/cm2, 5 minutes per session for 10 sessions. Visual Analog Scale (VAS) for pain severity and Western Ontario and McMaster universities Osteoarthritis Index (WOMAC) and the time up and go test (TUG) were evaluated before and after treatment in all groups. Results: The VAS, total WOMAC and TUG scores were significantly improved after treatment in all groups (P<0.001). The group receiving phonophoresis of dexamethasone ampoule showed more significant effects in reducing pain and improving function and mobility among three groups. Conclusion: Our results indicated that both ultrasound and phonophoresis of dexamethasone are effective methods in pain relief and improving function in mild and moderate knee osteoarthritis but phonophoresis of dexamethasone ampoule is better than the other treatments and it is suggested as an available method for treatment of knee osteoarthritis symptoms..

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The Efficacy and Duration of Intra-articular Corticosteroid Injection for Knee Osteoarthritis: A Systematic Review of Level I Studies

Cited by 196 publications

References 21 publications

Adding Triamcinolone Improves Viscosupplementation: A Randomized Clinical Trial

Adding Triamcinolone Improves Viscosupplementation: A Randomized Clinical Trial

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

Therapeutic Efficacy of Dexamethasone Phonophoresis on Symptomatic Knee Osteoarthritis in Elderly Women

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