Osteoarthritis (OA) is one of the foremost common chronic and debilitating diseases worldwide, with the knee and therefore the hip being the joints most ordinarily affected. Intra-articular corticosteroid injection has been used for many years to treat patients with knee and hip OA, especially individuals who cannot tolerate the side effects of long-term pharmaceutical therapy with acetaminophen and nonsteroidal anti-inflammatory drug drugs.
A recent analysis of the Medicare sample database found that quite one-third of patients with newly diagnosed knee OA were treated with a minimum of one intra-articular steroid injection.
Although its exact mechanism of action remains unknown, intra-articular corticosteroid injection is assumed to supply pain relief in patients with knee and hip OA by decreasing joint inflammation. Short-term complications, including septic arthritis, injection site pain, skin pigmentation, and atrophy, and systemic effects are exceedingly rare.
Radiologists are commonly asked to perform intra-articular corticosteroid injections in patients with knee and hip OA in clinical practice. Unfortunately, most radiologists don’t have a full understanding of the beneficial effects and potential complications of the procedure they’re performing.
In this issue of Radiology, Kompel and colleagues provide a special report highlighting joint-related complications related to intra-articular corticosteroid injection. The report describes the adverse joint events that occurred in 459 patients with knee and hip OA who received a minimum of one intra-articular corticosteroid injection at an inner-city hospital within us in 2018.
Thirty-six (8%) adverse joint events with imaging documentation were reported, with the overwhelming majority occurring in individuals with moderate Kellgren-Lawrence grade 3 knee and hip OA on radiographs. the foremost common adverse event was accelerated OA progression, followed by subchondral insufficiency fracture, osteonecrosis, and rapid joint destruction with bone loss.
The special report has several limitations in study design, including the tiny number of patients. It also lacks standardized clinical and imaging follow-up after intra-articular corticosteroid injection. The report is neither a prospective clinical test nor a retrospective observational study.
Its main purpose is education. the target is to teach radiologists that the intra-articular corticosteroid injection they routinely perform with little, if any, considered long-term safety may cause more harm than benefit.
The report provides illustrative case samples of accelerated OA progression, subchondral insufficiency fracture, osteonecrosis, and rapid joint destruction with bone loss and includes an in-depth overview of every individual adverse joint event. The report concludes that the radiology community should strive to raised understand potential adverse joint events after intra-articular corticosteroid injection to avoid possible complications.
Compel and colleagues raise several details that ought to be emphasized. First, the clinical benefits of intra-articular corticosteroid injection remain unknown. Studies have documented short-term pain relief in patients with knee OA after intra-articular corticosteroid injection, but the precise duration of the pain relief remains controversial.
A 2015 Cochrane Review update described the results of a meta-analysis of 27 clinical trials investigating the efficacy of intra-articular corticosteroid injection to treat knee OA.
The meta-analysis concluded that the clinical benefits of intra-articular corticosteroid injection at 1–6 weeks remain unclear thanks to the inferiority of evidence and located no remaining beneficial effect 6 months after injection. due to limited high-quality clinical data, even the American Academy of Orthopedic Surgeons doesn’t support an evidence-based recommendation that intra-articular corticosteroid injection is an appropriate treatment option for knee and hip OA.
However, the utilization of intra-articular corticosteroid injection to treat OA remains commonplace in clinical practice despite the shortage of strong evidence supporting its efficacy.