Corticosteroid/Ropivacaine Versus Corticosteroid/Saline Injections for Knee Osteoarthritis
Condition: Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Intervention: Ropivacaine; Normal saline; Methylprednisolone
Intervention description: 4cc 0.5% ropivacaine; 4cc of sterile normal saline (0.9%); 1cc 40mg methylprednisolone
Intervention MeSH terms: Methylprednisolone; Methylprednisolone Acetate; Methylprednisolone Hemisuccinate; Prednisolone; Prednisolone acetate; Ropivacaine; Prednisolone hemisuccinate; Prednisolone phosphate
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Enrollment: 29.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: osteoarthritis; injection; steroid; anesthetic

Summary:

      Corticosteroid injections are commonly used for the symptomatic treatment of knee
      osteoarthritis. Common practice is to inject the joint with a combination of corticosteroid
      and local anesthetic, with the rationale of providing longer duration pain relief with the
      corticosteroid and immediate, though short duration relief with the anesthetic. However,
      multiple in vitro and animal studies have shown that local anesthetic may be harmful to
      chondrocytes. Despite this data, use of intra-articular anesthetic remains widespread. Many
      clinicians believe incorporating the anesthetic is important because it can provide immediate
      pain relief and facilitate patient confidence in the treatment program. However, there is no
      published data to validate this reasoning. Therefore, the anesthetic has unknown clinical
      benefit and may have adverse effects on articular cartilage. In light of this, the
      investigators question the routine use of anesthetics in joint injections. The purpose of
      this study is to compare the effects of knee joint injections using: 1) corticosteroid with
      local anesthetic versus 2) corticosteroid with normal saline.
    

Eligibility criteria:

        Inclusion criteria:

          1. Age 18 or older

          2. Knee osteoarthritis (uni- or bilateral) as defined by the American College of
             Rheumatology (staged by Kellgren-Lawrence radiographic grading scale)

        Exclusion criteria:

          1. Rheumatologic/inflammatory disease

          2. Metabolic bone disease

          3. Crystalline arthropathy

          4. Current smoking

          5. BMI > 40

          6. Knee injection with corticosteroid or viscosupplementation within previous 6 months

          7. History of knee prolotherapy, platelet rich plasma or cellular (stem cell) injection

          8. Knee surgery within the last year

          9. Chronic opioid use

         10. Chronic pain syndrome/fibromyalgia

         11. Pain behavior during the clinical encounter as judged by the injecting physician

         12. Physician specifically ordered injection of corticosteroid/anesthetic or other
             specific combined corticosteroid injection

         13. Diagnostic uncertainty by referring provider

         14. Referral for bilateral knee or multiple joint injections (*note that arthritis
             involving multiple joints alone is not an exclusion criteria, only the patient
             receiving more than 1 injection)