Intra-articular injections for osteoarthritis

Kloppenburg, 2019 Kroon, 2014 Sakellariou, 2017 Bannuru, 2019

The approach to managing osteoarthritis, and the role of intra-articular injections for pain relief, is described in Components of management for osteoarthritis.

A single intra-articular corticosteroid injection may provide short-term symptom relief in patients with knee or hip osteoarthritis. Because of their rapid onset of action, intra-articular corticosteroid injections may be useful if patients need to travel or participate in an important occasion; they may also enable participation in exercise programs. Hip injections require radiological guidance; however, knee injections are easily performed with landmark guidance and radiological guidance does not increase their effectiveness. Intra-articular corticosteroid injection may be repeated at 3-monthly intervals if needed. If a patient is being considered for joint replacement, avoid injecting the joint with a corticosteroid in the 6 months before the surgery to minimise the risk of infection. If the timing of the patient’s surgery is not known, discuss the appropriateness of a corticosteroid injection with the patient’s orthopaedic surgeon.

Note: If there is any doubt about when to avoid injecting a corticosteroid into a joint being considered for replacement, seek advice from the patient’s orthopaedic surgeon.

For principles of using local corticosteroid injections and example doses, see Principles of using local corticosteroid injections for musculoskeletal pain.

Intra-articular hyaluronan (hyaluronic acid) is used by some clinicians for patients with knee osteoarthritis who have significant functional impairment despite nonpharmacological and first-line pharmacological therapies. Recent evidence shows that intra-articular hyaluronan is not more effective than placebo but is associated with harms (eg temporary worsening of osteoarthritis symptoms). It is also more expensive than intra-articular corticosteroid injectionRutjes, 2012.

Intra-articular injections of platelet-rich plasma (PRP), adipocyte cell suspensions and mesenchymal stem cells are not recommended for use in patients with osteoarthritis because evidence shows they provide no benefitKearney, 2021 Paget, 2021. They are also associated with significant expense for the patient.

For discussion of intra-articular injections for hand osteoarthritis, see Osteoarthritis of the hand.