Skip to main content
SpringerLink
Log in

Will a single periarticular lidocaine–corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis?

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A local injection of corticosteroid–lidocaine into the periarticular soft tissue structures is used commonly for rapid pain relief. It is hypothesized that knee pain associated with knee osteoarthritis would be relieved quickly and effectively in patients receiving intraarticular hyaluronic acid combined with a periarticular lidocaine–corticosteroid injection. To test this hypothesis, the clinical effect of the combined treatment with hyaluronic acid injection alone in patients with symptomatic knee osteoarthritis as compared in this prospective single-blinded randomized trial.

Methods

This study included 70 patients. Group 1 (n = 35) received intraarticular hyaluronic acid injections only, whereas group 2 (n = 35) received intraarticular hyaluronic acid injections combined with a single local injection of corticosteroid–lidocaine. Injections were administered to the most painful areas of the anterior or posterior medial condyle of the femur or tibia. The outcome was measured by independent assessors (blinded to treatment) using a linear VAS pain scale and WOMAC and HSS knee scores. Assessments were performed at baseline and at 1, 3, 6, 12, 26, and 52 weeks.

Results

During the first 3 weeks, group 2 patients showed significantly better all scores than did group 1 patients (p < 0.01). However, no significant differences were detected at 6, 12, 26 or 52 weeks (n.s.).

Conclusion

The combined treatment may lead to earlier pain relief compared with intraarticular hyaluronic acid alone in patients with knee osteoarthritis and can be considered a useful adjunctive treatment modality. This combined method may provide early return to patient’s daily activity.

Level of evidence

Therapeutic study, Level I.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Altman R, Asch E, Bloch D et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 29:1039–1049

    Article  CAS  PubMed  Google Scholar 

  2. Altman RD, Rosen JE, Bloch DA et al (2009) A double-blind, randomized, saline-controlled study of the efficacy and safety of EUFLEXXA for treatment of painful osteoarthritis of the knee, with an open-label safety extension (the FLEXX trial). Semin Arthritis Rheum 39:1–9

    Article  CAS  PubMed  Google Scholar 

  3. Alvarez-Nemegyei J (2007) Risk factors for pes anserinus tendinitis/bursitis syndrome: a case control study. J Clin Rheumatol 13:63–65

    Article  PubMed  Google Scholar 

  4. Axe JM, Snyder-Mackler L, Axe MJ (2013) The role of viscosupplementation. Sports Med Arthrosc 21(1):18–22

    Article  PubMed  Google Scholar 

  5. Bannuru RR, Natov NS, Obadan IE et al (2009) Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum 61(12):1704–1711

    Article  CAS  PubMed  Google Scholar 

  6. Bannuru RR, Vaysbrot EE, Sullivan MC et al (2014) Relative efficacy of hyaluronic acid in comparison with NSAIDs for knee osteoarthritis: a systematic review and meta-analysis. Semin Arthritis Rheum 43(5):593–599

    Article  CAS  PubMed  Google Scholar 

  7. Bellamy N, Buchanan WW, Goldsmith CH et al (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  8. Bellamy N, Campbell J, Robinson V et al (2006) Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 19:(2):CD005321

    Google Scholar 

  9. Brandt KD (2011) Why should we expect a structure-modifying osteoarthritis drug to relieve osteoarthritis pain? Ann Rheum Dis 70:1175–1177

    Article  PubMed  Google Scholar 

  10. Chou CW, Lue KH, Lee HS (2009) Hylan G-F 20 has better pain relief and cost-effectiveness than sodium hyaluronate in treating early osteoarthritic knees in Taiwan. J Formos Med Assoc 108:663–672

    Article  CAS  PubMed  Google Scholar 

  11. Collins NJ, Bierma-Zeinstra SM, Crossley KM et al (2013) Prognostic factors for patellofemoral pain: a multicentre observational analysis. Br J Sports Med 47(4):227–233

    Article  PubMed  Google Scholar 

  12. Creamer P (1997) Intra-articular corticosteroid injections in osteoarthritis: do they work and if so, how? Ann Rheum Dis 56(11):634–636

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. de Campos GC, Rezende MU, Pailo AF et al (2013) Adding triamcinolone improves viscosupplementation: a randomized clinical trial. Clin Orthop Relat Res 471(2):613–620

    Article  PubMed  Google Scholar 

  14. Folman Y, Shabat S (2011) Local treatment of a painful knee with cortiscosteroids: the efficacy of intra-articular injection compared with peri-articular soft tissue infiltration. J Musculoskelet Pain 19:154–157

    Article  Google Scholar 

  15. Gigante A, Callegari L (2011) The role of intra-articular hyaluronan (Sinovial) in the treatment of osteoarthritis. Rheumatol Int 31(4):427–444

    Article  PubMed  Google Scholar 

  16. Gomoll AH, Kang RW, Williams JM et al (2006) Chondrolysis after continuous intra-articular bupivacaine infusion: an experimental model investigating chondrotoxicity in the rabbit shoulder. Arthroscopy 22:813–819

    Article  PubMed  Google Scholar 

  17. Helfenstein M Jr, Kuromoto J (2010) Anserine syndrome. Rev Bras Reumatol 50:313–327

    Article  PubMed  Google Scholar 

  18. Housman L, Arden N, Schnitzer TJ et al (2014) Intra-articular hylastan versus steroid for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 22(7):1684–1692

    Article  PubMed  Google Scholar 

  19. Iannitti T, Lodi D, Palmieri B (2011) Intra-articular injections for the treatment of osteoarthritis: focus on the clinical use of hyaluronic acid. Drugs R D11:13–27

    Article  Google Scholar 

  20. Inês LP, da Silva JA (2005) Soft tissue injections. Best Pract Res Clin Rheumatol 19:503–527

    Article  PubMed  Google Scholar 

  21. Insall JN, Ranawat CS, Aglietti P et al (1976) A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am 58:754–765

    Article  CAS  PubMed  Google Scholar 

  22. Jørgensen A, Stengaard-Pedersen K, Simonsen O et al (2010) Intra-articular hyaluronan is without clinical effect in knee osteoarthritis: a multicentre, randomised, placebo-controlled, double-blind study of 337 patients followed for 1 year. Ann Rheum Dis 69:1097–1102

    Article  PubMed  Google Scholar 

  23. Karatosun V, Unver B, Gocen Z (2006) Intra-articular hyaluranic acid compared with progressive knee exercises in osteoarthritis of the knee: a prospective randomized trial with long-term follow-up. Rheumatol Int 26:277–284

    Article  CAS  PubMed  Google Scholar 

  24. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheumatol Dis 16:494–502

    Article  CAS  Google Scholar 

  25. Leighton R, Akermark C, Therrien R et al (2014) NASHA hyaluronic acid vs. methylprednisolone for knee osteoarthritis: a prospective, multi-centre, randomized, non-inferiority trial. Osteoarthr Cartil 22(1):17–25

    Article  CAS  PubMed  Google Scholar 

  26. Leopold SS, Redd BB, Warme WJ (2003) Corticosteroid compared with hyaluronic acid injections for the treatment of osteoarthritis of the knee. A prospective, randomized trial. J Bone Joint Surg Am 85A:1197–1203

    Article  Google Scholar 

  27. Lirk P, Picardi S, Hollmann MW (2014) Local anaesthetics: 10 essentials. Eur J Anaesthesiol 31:1–11

    Article  Google Scholar 

  28. Liu L, Liu Y, Li J (2011) Microbial production of hyaluronic acid: current state, challenges, and perspectives. Microb Cell Fact 16(10):99

    Article  Google Scholar 

  29. Nichols AW (2005) Complications associated with the use of corticosteroids in the treatment of athletic injuries. Clin J Sport Med 15(5):370–375

    Article  PubMed  Google Scholar 

  30. Ozturk C, Atamaz F, Hepguler S (2006) The safety and efficacy of intraarticular hyaluronan with/without corticosteroid in knee osteoarthritis: 1-year, single-blind, randomized study. Rheumatol Int 26:314–319

    Article  CAS  PubMed  Google Scholar 

  31. Papacrhistou G, Anagnostou S, Katsorhis T (1997) The effect of intraarticular hydrocortisone injection on the articular cartilage of rabbits. Acta Orthop Scand Suppl 275:132–134

    Article  CAS  PubMed  Google Scholar 

  32. Raman R, Dutta A, Day N (2008) Efficacy of hylan G-F 20 and sodium hyaluronate in the treatment of osteoarthritis of the knee—a prospective randomized clinical trial. Knee 15:318–324

    Article  CAS  PubMed  Google Scholar 

  33. Scott NA, Guo B, Barton PM (2009) Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med 10:54–69

    Article  PubMed  Google Scholar 

  34. Simons DG (2004) Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol 14:95–107

    Article  PubMed  Google Scholar 

  35. Stephens MB, Beutler AI, O’Connor FG (2008) Musculoskeletal injections: a review of the evidence. Am Fam Physician 78(8):971–976

    PubMed  Google Scholar 

  36. Uson J, Aguado P, Bernad M (2000) Pes anserinus tendino-bursitis: what are we talking about? Scand J Rheumatol 29:184–186

    Article  CAS  PubMed  Google Scholar 

  37. Wang CT, Lin J, Chang CJ (2004) Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am 86A:538–545

    Article  Google Scholar 

  38. Yentür EA, Okçu G, Yegül I (2004) The role of trigger point therapy in knee osteoarthritis. The Pain Clinic 15:385–390

    Article  Google Scholar 

  39. Yoon HS, Kim SE, Suh YR (2005) Correlation between ultrasonographic findings and the response to corticosteroid injection in pes anserinus tendinobursitis syndrome in knee osteoarthritis patients. J Korean Med Sci 20:109–112

    Article  PubMed  PubMed Central  Google Scholar 

  40. Zhang W, Moskowitz RW, Nuki G et al (2008) OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil 16(2):137–162

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Harran University Faculty of Medicine, 63100, Yenisehir, Sanliurfa, Turkey

    Cemil Ertürk, Mehmet Akif Altay & İbrahim Avşin Öztürk

  2. Department of Anesthesiology and Reanimation, Harran University Faculty of Medicine, Sanliurfa, Turkey

    Nuray Altay

  3. Department of Orthopaedic Surgery, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey

    Ali Murat Kalender

Authors
  1. Cemil Ertürk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehmet Akif Altay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nuray Altay
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ali Murat Kalender
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. İbrahim Avşin Öztürk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cemil Ertürk.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ertürk, C., Altay, M.A., Altay, N. et al. Will a single periarticular lidocaine–corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis?. Knee Surg Sports Traumatol Arthrosc 24, 3653–3660 (2016). https://doi.org/10.1007/s00167-014-3398-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3398-2

Keywords

Search

Navigation