Intra-articular Knee Steroid Injections Efficiency in Stage 3-4 Gonarthrosis
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Research
P: 372-376
December 2018

Intra-articular Knee Steroid Injections Efficiency in Stage 3-4 Gonarthrosis

Med J Bakirkoy 2018;14(4):372-376
1. İstanbul Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, İstanbul, Türkiye
2. İstanbul Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye
3. Acıbadem Mehmet Ali Aydınlar Üniversitesi Atakent Hastanesi, Anestezi ve Reanimasyon Kliniği, İstanbul, Türkiye
No information available.
No information available
Received Date: 08.12.2017
Accepted Date: 16.01.2018
Publish Date: 28.12.2018
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ABSTRACT

Conclusion:

Different treatment options are applied according to the stage of knee osteoarthritis. Intra-articular injections, physiotherapy and non-steroid anti-inflammatory drugs are commonly used conservative treatment modalities. Steroids and hyaluronic acid derivatives can be administered separately or together at intra-articular knee injections. Intra-articular knee injections are preferred in combination treatment of early-stage gonarthrosis due to rapid pain relief and replicable. Intra-articular knee steroid injections suggested for patients who don’t consider the surgery or want to save time.

Results:

A total of 151 knees from 101 patients aged between 48 to 88 (67.49±8.99) (F=77, M=31) were included. Of the cases, 55.6% (n=84) right and 44.4% (n=67) left knee were injected; 29.8% (n=45) were stage 3 and 70.2% (n=70.2) were stage 4. Pre-injection VAS score was 8.34±0.75, the VCS was 4.29±0.48; post-injection VAS score was 3.68±1.59, and VCS was 2.22±0.8 (p<0.001).

Materials and Methods:

A total of 151 knees from 108 patients who were admitted to the orthopedics clinic with long-lasting knee pain and who had radiological grade 3-4 gonarthrosis according to the Kellgreen-Lawrence classification were included in the study. Pain scores were compared according to the Visual Analogue scale (VAS) and Verbal Category scale (VCS) before the injection and at 6-week post injection. Combination of 9 ccs 2% prilocaine and 1 cc triamcinolone hexacetonide injection was applied intra-articular.

Objective:

Gonarthrosis is a chronic non-inflammatory, degenerative disease that starts with joint pain, movement limitation, as a result of joint cartilage damage in the knee joint. In gonarthrosis, patient education, rest, preventive measures, pharmacological, physical therapy and surgical treatment methods can be used alone or together according to the stages of the disease. Intra-articular injections are used to reduce pain and increase functional movements in gonarthrosis. The aim of this study is to evaluate the effect of intra-articular knee steroid injection on the knee pain.

Keywords:
Steroid, intra-articular injection, VAS score

References

1
Oğuz H. Eklemlerin yapısı ve fonksiyonu, osteoartroz, diz ağrıları. In: Oğuz H. Romatizmal ağrılar. Atlas Tıp Kitabevi 1992:349-363.
2
Greenwald RA. Oxygen radicals, inflamation, and arthritis: pathophsiological considerations and implications for threathment. Semin Arthritis Rheum 1991;20:219-40.
3
Regan EA, Bowler RP, Crapo JD. Joint fluid antioxidants are decreased in osteoarthritic joints compared to joints with macroscopically intact cartilage and subacute injury. Osteoarthritis Cartilage 2008;16:515-21.
4
Wen DY. Intra-articular hyaluronic acid injections for knee osteoarthritis. Am Fam Physician 2000;162:65-572.
5
Felson DT. Osteoarthritis. Rheum Dis Clin of North America 1990;16:499-512.
6
Atay T, Aslan A, Baydar ML, Ceylan B, Baykal B, Kırdemir V. Gonartrozlu hastalarda artroskopik debridman sonrası viskosüplemantasyon uygulamalarının karşılaştırılması. Acta Orthop et Traumatol Turc 2008;42:228-33.
7
Elmalı N, İnan M, Ertem K, Esenkaya İ, Ayan İ, Karakaplan M. Diz osteoartritinin artroskopik debridman ve intraartiküler hyalüronik asit ile tedavisi. J Arthroplasty Arthroscopic Surg 2002;13:131-5.
8
Kullenberg B, Runesson R, Tuvhag R, Olsson C, Resch S. Intraarticular corticosteroid injection: pain relief in osteoarthritis of the hip. J Rheumatol 2004;31:2265-8.
9
Raynauld JP, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficiacy of long term intraarticular steroid injections in osteoarthritis of the knee: randomized, double blind, placebo-controlled trial. Arthritis Rheum 2003;48:370-7.
10
Uysal G.F, Başaran S. Diz osteoartriti. Türk Fiz Tıp Reab Derg 2009;55:1-7
11
Petersson IF, Boegard T, Saxne T, Silman AJ, Svensson B. Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgreen&Lawrence systems for the tibiofemoral joint in people aged 35-54 years with chronic knee pain. Ann Rheum Dis 1997;56:493-6.
12
Aslan FE. Ağrı Değerlendirme yöntemleri. C.U. Hemşirelik Yüksekokulu Dergisi 2002;6:9-16.
13
Wittich CM, Ficalora RD, Mason TG, Beckman TJ. Musculoskeletal Injection. Mayo Clin Proc 2009;84:831-7.
14
Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treathment of osteoathritis of the knee. Cochrane Database Syst Rev 2006;(2):CD005328
15
Furtado RNV, Machado FS, Luz KR, Santos MF, Konai MS, Lopes RV, Natour J. Intra-articular injection with triamcinolone hexacetonide in patients with rheumatoid arthritis: prospective assessment of goniometry and joint inflammation parameters. Rev Bras Reumatol 2016;319:1-7.
16
Stephens BM, Beutler IA, O’Connor GF. Musculoskeletal Injections: A Review of the Evidence. Am Fam Physician 2008;78:971-6.
17
Aroll B, Goodyear-Smith F. Corticosteroid injections for the osteoarthritis of the knee: meta-analysis. BMJ 2004;328(7444):869.
18
Uğur M, Tuğuç A, Melikoğlu MA, Yıldırım K, Şenel K. Diz dejeneratif osteoartritli hastalarda intraartiküler hyalüronik asit ile intraartiküler metil prednizolon asetatın etkinliklerinin karşılaştırılması. Eurasian Journal of Medicine 2007;39:185-8.
19
Babor DA, Harris SR. Oxygen free radicals and antioxidants: A review. Am Pharm 1994;296:555-63.
20
Aslan A, Aydoğan NH, İlhan M, Özerdemoğlu RA, Altuntaş İ, Yorgancıgil H. The effect of different intraarticular drug applications to the antioxidation system and lipid peroxidation in gonarthrozis. Gaziantep Med J 2012;18:1-6.
21
Tekeoğlu İ, Adak B. Diz osteoartritinde intraartiküler sodyum hyaluronat ile betametazon etkilerinin karşılaştırılması. Romatol Tıp Rehab 1998;9:220-4.
22
Flanagan J, Thomas TL, Casale FF, Desai KB. İntraarticular injection for pain relief in patients awaiting hip replacement. Ann Roy Coll Surg Engl 1988;70:156-7.
23
Lambert RGW, Hutchings EJ, Grace MGA, Jhangri GS, Conner Spady B, Maksymowich WP. Steroid injections for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2007;56:2278-87.
24
Öncü J, Çelebi G, İlişer R, Kuran B, Durlanık G. Koksartroz tanılı olgularda floroskopi altında uyguladığımız intraartiküler kortikosteroid enjeksiyonun üç aylık verileri. Okmeydanı Tıp Dergisi 2014;30:1-5.