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Intra-articular corticosteroid injections are associated with a dose-dependent risk of total knee arthroplasty at 5 years

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Intra-articular corticosteroid injections (CSI) are used commonly for the non-operative management of patients with knee pain. Recent literature has raised concern for chondrotoxicity of CSI. The purpose of the present study is to evaluate for any dose-dependent association between CSI in non-osteoarthritic knees and subsequent total knee arthroplasty (TKA).

Methods

The Pearl Diver database identified patients with a diagnosis of knee pain without concomitant osteoarthritis who were administered CSI over a 2-year period. Patients were compared to matched and unmatched cohorts. The primary endpoint was the incidence of TKA at 5 years. Multivariable regression analysis was used to assess CSI quantity as an independent risk factor.

Results

49,443 of 986,162 (5.0%) Patients diagnosed with knee pain without concomitant knee osteoarthritis who received at least one CSI were identified. At 5 years, there was a higher incidence of TKA in the matched injection cohort relative to the non-injection matched cohort (0.26 vs 0.13%; p < 0.001) and unmatched cohort (0.26 vs. 0.10%, p < 0.001). The quantity of CSI corresponded with an increased probability of TKA at 5 years; one injection: 0.22% (OR 1.23, 95% CI [0.87–1.74], p = 0.236); two injections: 0.39% (OR 1.98 CI [1.06–3.67], p = 0.03, three or more injections: 0.49% (OR 3.22 CI [1.60–6.48], p = 0.001). The average time to TKA after one CSI was 3.03 ± 2.29 years. This time was nearly halved with three CSI (1.78 ± 0.80 years, p < 0.001).

Conclusions

Intra-articular corticosteroid injections in patients without knee osteoarthritis at the time of injection are associated with a dose-dependent risk of TKA at 5 years. CSI may not be as benign of a treatment modality as previously thought.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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  1. Midwest Orthopaedics at Rush LLC, 1611 W Harrison St, Suite 300, Chicago, IL, 60612, USA

    Robert A. Burnett III, Syed Khalid, Anne DeBenedetti, E. Bailey Terhune, Morgan L. Angotti & Craig J. Della Valle

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  1. Robert A. Burnett III
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  2. Syed Khalid
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  3. Anne DeBenedetti
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  4. E. Bailey Terhune
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Correspondence to Craig J. Della Valle.

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Burnett, R.A., Khalid, S., DeBenedetti, A. et al. Intra-articular corticosteroid injections are associated with a dose-dependent risk of total knee arthroplasty at 5 years. Knee Surg Sports Traumatol Arthrosc 31, 426–431 (2023). https://doi.org/10.1007/s00167-022-07017-z

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  • DOI: https://doi.org/10.1007/s00167-022-07017-z

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