Research Information System
RSNA 2022, Illinois, United States Of America, 27 November - 01 December 2022, pp.1
Impact of Intra-Articular Knee Injections on the Progression of Knee Osteoarthritis: Data From the Osteoarthritis Initiative (OAI) Cohort PURPOSE To evaluate the association between the type of intra-articular knee injection (corticosteroid, hyaluronic acid) and progression of knee osteoarthritis (OA) compared to controls, assessed semi-quantitatively using wholeorgan magnetic resonance imaging scores (WORMS) over 2 years. METHODS AND MATERIALS Methods and Materials Participants (n=60: 36 female, age 62.2 [45.0, 79.0] years, BMI 28.3 [18.9, 38.3] kg/m2) from the Osteoarthritis Initiative (OAI) cohort who received a single injection of corticosteroid (n=8), hyaluronic acid (n=12), and controls (n=40) propensity-score matched on age, sex, BMI, KellgrenLawrence (KL) grade, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Physical Activity Scale for the Elderly (PASE) were selected at the timepoint when the injection was administered. 3T MRIs obtained at baseline, 2 years prior, and 2 years after the injection were semiquantitatively graded using WORMS for the meniscus, bone marrow lesions, cartilage, joint effusion, and ligaments. Progression of OA was quantified using the difference in WORMS between baseline and 2-year follow-up. Linear regression models, adjusted for age, sex, BMI, KL grade, WOMAC, PASE, were used to identify association between the type of injection (corticosteroid vs controls, hyaluronic acid vs controls) and progression of WORMS. A p-value < 0.05 was considered statistically significant. RESULTS Significant association was found between corticosteroid injection and post-injection progression of WORMS over 2 years for the knee overall (p=0.03), lateral meniscus (p=0.02), lateral cartilage (p=0.03), and medial cartilage (p=0.002). No significant association (p > 0.05) was found between hyaluronic acid injection and post-injection progression of WORMS over 2 years. No significant association was found between either injection type and progression of pain over 2 years quantified by WOMAC (p > 0.05). No significant difference (p > 0.05) was found in progression of WORMS over the 2 years prior to injection for corticosteroid and hyaluronic acid injections.
CONCLUSIONS Corticosteroid knee injections were significantly associated with the progression of knee OA assessed semiquantitatively using WORMS as an outcome. Hyaluronic acid knee injections, however, did not show a significant association with the progression of knee OA. CLINICAL RELEVANCE/APPLICATIONS While both corticosteroid and hyaluronic acid injections are said to help with symptomatic pain relief in knee OA, in this study, hyaluronic acid injections did not show any progression of knee OA up to 2 years postinjection while progression was demonstrated with corticosteroid injections.