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Management of moderate osteoarthritis of the knee

Any role of a steroid injection?

How does it compare to a Hyaluronic acid injection?

Let’s look at the results of a recently published clinical trial.

Intra-Articular, Single-Shot Hylan G-F 20 Hyaluronic Acid Injection Compared with Corticosteroid in Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial

Tammachote N et al, J Bone Joint Surg Am. 2016 Jun 1;98(11):885-92


So, you have moderate knee arthritis and simple analgesics and activity modification have not provided significant relief?

This is a very common problem often seen in elderly people. Optimising nonoperative management and considering a variety of measures to control pain and delaying surgery is a priority in the management of mild to moderate arthritis.

Injections are sometimes used in clinical practice. One such injection is the Hylan G-F 20 which is given as a single injection into the knee joint that can be repeated after 6 months. This injection is currently not included in the PBS schedule and incurs an out of pocket expense for the patient. Another injection is the cortisone injection (eg triamcinolone acetonide injection) which is much cheaper. Is one better than the other?

What did this study find?

Over the first two weeks a single injection of corticosteroid and local anaesthetic provided better pain relief and better patient reported arthritis related function scores (better function and movement in the knee) compared to hyaluronic acid.

At 1 month and 6 months there was no difference in the outcome measures between the corticosteroid and hylan G-F 20 groups.

It appears a corticosteroid injection that is much cheaper provides equivalent results to the hylan injection in the short term. But long term followup studies are required to see how long the improvement lasts in each group.