David F. Dalury
LAS VEGAS — Although corticosteroid injections appear to offer short-term benefits regarding pain and function for patients with knee arthritis, a presenter here noted no guidance is available in the terms of frequency and dosage.
In his presentation at The Knee Society Specialty Day at the American Academy of Orthopedic Surgeons Annual Meeting, David F. Dalury, MD, noted that data are unclear on whether corticosteroid injections work in treatment of knee arthritis.
“Most of the studies are small and underpowered,” Dalury said. “There does appear to be a benefit compared to placebo.”
Although triamcinolone and methyleprednisolone are the most common drugs used in injections, he added there is no evidence about efficacy, what the lifetime number of injections are or whether the dosages should be hemodiluted. Dalury also noted mixed data on the risk of chondrotoxicity for corticosteroid injections.
“You will hear stories of destruction in the shoulder, but those have not been reported in our regular basis in the knee,” he said. “Ropivacaine supposedly has the lowest risk because it lowers the dose and it has a less chondrotoxicity. That is not something that we routinely do.”
However, systemic effects are rare and risk of infection is small, according to Dalury. He noted patients have significant elevation of blood glucose at 3 to 6 hours post-injection and of up to 48 hours in patients with diabetes. Although there is a general acceptance of a 3-month frequency for injection, Dalury noted there is no data on frequency and dosing of corticosteroid injections.
“There is no identified limit of the number of injections,” Dalury said. “There is soft evidence to avoid surgery for 90 days up to 180 days. You should not have an arthroplasty within those time periods of that injection.” – by Casey Tingle
Dalury DF. Corticosteroid injections: Do they really work? Presented at: American Academy of Orthopaedic Surgeons Annual Meeting Specialty Day; March 16, 2019; Las Vegas.
Disclosure: Dalury reports he receives IP royalties and research support from and is a paid consultant and paid presenter or speaker for DePuy and receives stock or stock options from Johnson & Johnson and Robony.