Comparison for IA corticosteroid versus saline injection following lavage for knee OA

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
77 patients with knee osteoarthritis underwent knee arthroscopy & joint lavage, followed by an intra-articular injection of corticosteroid (120mg methylprednisolone acetate) or placebo saline, assigned randomly. The outcomes assessed included patient-reported pain and function, response rate (minimum 30% reduction in pain from baseline), and relapse rate at 2, 4, 8, 12, and 24-week follow-ups. Results demonstrated no Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: National Health and Medical Research Council of Australia; Arthritis Foundation of Australia
Conflicts: None disclosed
CONTENT IS LOCKED
Why was this study needed now?
Knee osteoarthritis is a leading cause of disability in the adult population, and inflammation of the joint is thought to be a contributing factor to the progression of the disease. Corticosteroids are a form of treatment that have a strong anti-inflammatory effect. At the time of this study, few randomized controlled trials had been conducted to compare the effect of intra-articular corticosteroid injections to placebo injections, especially following arthroscopic joint lavage.
What was the principal research question?
What is the comparative efficacy between joint lavage with and without an additional corticosteroid injection in the treatment of knee osteoarthritis when assessed over 24-week follow-up period?
Population: 77 patients with symptomatic knee osteoarthritis. All patients underwent arthroscopy with joint lavage, at which time cartilage degradation throughout the joint was graded by an orthopaedic surgeon and rheumatologist on a scale from 0 to 4 (Kellgren-Lawrence classification system).
Intervention: IA corticosteroid group: Following the completion of arthroscopy and joint lavage, patients were administered an intra-articular injection of 120mg methylprednisolone acetate. For patients who demonstrated relapse (see below in Outcomes section), patients were offered re-treatment with arthroscopy, lavage, and IA corticosteroid injection. (n=39)
Comparison: IA placebo group: Following the completion of arthroscopy and joint lavage, patients were administered an intra-articular injection of normal saline. For patients who demonstrated relapse (see below in Outcomes section), patients were offered re-treatment with arthroscopy, lavage, and IA corticosteroid injection. (n=38)
Outcomes: Clinical assessment included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Lequesne Functional Index, pain at rest and on movement using a visual analog scale (0-10cm VAS), presence/absence of knee effusion, and knee range of motion. A response was defined as a minimum 30% reduction from baseline in VAS pain on movement, and relapse was defined as an increase in VAS pain on movement to within baseline minus 20%. The OMERACT-OARSI criteria for responder rate was also analyzed, defined as a relative reduction from baseline in VAS pain of at least 20%, and an improvement in function of at least 20% relative to baseline or absolute 10-point increase from baseline. A radiographic evaluation was performed, grading knee osteoarthritis using the Kellgren-Lawrence classification system.
Methods: RCT; Assessor-blind; Single-center
Time: Follow-up scheduled for 2, 4, 8, 12, and 24 weeks post-intervention.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.