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

Dr. Hepper is Resident, Department of Orthopaedics, Washington University School of Medicine, St. Louis, MO. Dr. Halvorson is third-year resident, Department of Orthopaedics, Wake Forest University, Winston-Salem, NC. Dr. Duncan is third-year resident, Department of Orthopaedics, University of Kentucky, Lexington, KY. Dr. Gregory is Assistant Professor, Departments of Orthopaedics and Pediatrics, Vanderbilt University Medical Center, Nashville, TN. Dr. Dunn is Assistant Professor of Orthopaedics, and Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University Medical Center. Dr. Spindler is Professor of Orthopaedics and Rehabilitation, Vanderbilt University School of Medicine.

This work was funded in part by the Vanderbilt Sports Medicine Research Fund.

Dr. Dunn or a member of his immediate family has received research or institutional support from Arthrex and NIH/NIAMS grant no. 5K23 AR052392-04. Dr. Spindler or a member of his immediate family serves as a board member, owner, officer, or committee member of the American Orthopaedic Society for Sports Medicine, the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and the Orthopaedic Research and Education Foundation; has received royalties from Connective Orthopaedics; is a member of a speakers’ bureau or has made paid presentations on behalf of the Musculoskeletal Transplant Foundation and Connective Orthopaedics; serves as a paid consultant to or is an employee of Connective Orthopaedics; has received research or institutional support from Arthrex, DJ Orthopaedics, Smith & Nephew, and NIH/NIAMS grant no. R01AR053684-01A1; has stock or stock options held in Connective Orthopaedics; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from the Scientific Advisory Board, Don Joy, and Smith & Nephew. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Hepper, Dr. Halvorson, Dr. Duncan, and Dr. Gregory.

Reprint requests: Dr. Spindler, Vanderbilt University, Medical Center East, South Tower, Suite 4200, 1215 21st Avenue South, Nashville, TN 47232-8774.

We performed a systematic review of the current literature to determine the efficacy and duration of intra-articular corticosteroid injection in reducing pain caused by knee osteoarthritis and to determine whether the type of corticosteroid used affected these results. Following an electronic search of multiple databases and a review of reference lists from various articles, we found six trials in five papers that compared corticosteroid versus placebo and four papers that compared different corticosteroids. Results of corticosteroid compared with placebo showed both a statistically and clinically significant reduction in pain at 1 week, with an average difference between groups of 22%. Two of four trials showed triamcinolone to be more effective in pain reduction than other corticosteroids. We concluded that intra-articular corticosteroids reduce knee pain for at least 1 week and that intra-articular corticosteroid injection is a short-term treatment of a chronic problem.