Joint Replacement Surgery Recovery

Corticosteroid injections in the knee are a common pain relief treatment for patients with osteoarthritis, but they’re not without controversy.

Previous research has suggested that such steroid injections cause people with knee osteoarthritis to have a threefold-higher risk of disease progression, but many patients in that research had more advanced knee arthritis. That’s also a risk factor for disease progression.

In new research presented at ACR Convergence 2020, the annual meeting of the American College of Rheumatology, researchers investigated whether corticosteroid injections for knee osteoarthritis did speed up the progression of the disease and lead to the need for having a total knee replacement surgery sooner.

“Clinicians and patients need to know if steroid injections are making knee osteoarthritis worse so they can make informed decisions about their treatment,” the study’s co-author, Justin J. Bucci, MD, Assistant Professor of Medicine at Boston University School of Medicine, said in a press release.

To determine the possible risks of steroid injections for patients with knee osteoarthritis, the researchers compared them with hyaluronic acid injections, another type of knee osteoarthritis treatment that has not been associated with cartilage loss and disease progression.

They used two large group studies of knee osteoarthritis patients who received either corticosteroid or hyaluronic acid injections to review the rates of radiographic progression (joint damage you can see on X-rays) and total knee replacement surgery.

Patients in the first group had medical visits once per year; those in the other group had visits every 30 months. The researchers compared X-rays from each medical visit before a patient’s first injection to those taken after their last injection, analyzing 792 knees in total (647 treated with corticosteroid injections and 145 treated with hyaluronic acid injections).

The rate of total knee replacement surgery was greater among patients with a single exam in which they reported hyaluronic acid injection, compared to those with a single exam in which they reported corticosteroid injection. The researchers did not see a difference in patients who reported injections at multiple exams.

Additional analysis showed that both injection treatments at either single or multiple medical exams had similar rates of X-ray progression.

Overall, the study findings show that corticosteroid injections are not associated with a higher risk of radiographic progression or progression to total knee replacement (two signs of worsening knee osteoarthritis) compared to hyaluronic acid injections.

“We did not find any association between steroid injections and worsening knee osteoarthritis in our study,” said Dr. Bucci. “Patients and clinicians should see this study and feel reassured that these injections are not causing progression of osteoarthritis or earlier total knee replacement.”

Next, Dr. Bucci’s team will research MRI (magnetic resonance imaging) of knees undergoing steroid injection treatment for osteoarthritis.

“MRI provides a more detailed look at structures within the knee compared to X-rays and these images were obtained as part of the [patient groups] we studied,” says Dr. Bucci. “This information will add to the findings from our current study, and give patients and clinicians a better understanding of what happens to knees treated with steroid injections.”

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Bucci J, et al. Progression of Knee OA with Use of Intra-articular Corticosteroids (CS) vs Hyaluronic Acid (HA) [abstract]. Arthritis & Rheumatology. November 2020.

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