Ultrasound (US)-Guided Versus Sham Ultrasound Corticosteroid (CS) Knee Injections

Study Overview
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Brief Summary
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To determine if ultrasound-guided knee steroid injections are more effective than sham ultrasound knee steroid injections for the treatment of osteoarthritis.

Official Title
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Ultrasound-guided Versus Sham Ultrasound Corticosteroid Knee Injections

Conditions
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Osteoarthritis

Intervention / Treatment
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* Procedure: Ultrasound
* Procedure: Sham ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 40 and 89. Meet the American College of Rheumatology criteria for knee OA with knee pain, aching or stiffness on most of the past 30 days and have evidence on radiograph of a definite osteophyte. Have a pain score of at least 4 out of 10 on an 11 point numeric rating scale. For participants with bilateral knee OA, the most symptomatic knee will be considered the study knee. If both knees are symptomatic, the subject will choose the one they want treated. Be able to speak and understand English. Have a telephone. Exclusion Criteria: Prior hyaluronic acid injection. Scheduled knee hyaluronic acid injections, arthroscopy, or knee surgery. Comorbid conditions including: known other causes of arthritis (infectious arthritis, rheumatoid arthritis, connective tissue disease, gout, pseudogout, or psoriatic arthritis), bony or soft tissue malignancy or skin lesions or peripheral neuropathy involving the lower extremities, cardiopulmonary disease which limits walking more than knee pain, knee instability defined as report of knee buckling or locking within the past month of the study knee, major neurologic deficit that affects gait, psychiatric illness that limits informed consent Current involvement in litigation or receiving workmen's compensation. These patients are to be excluded because they are expected to bias results. This group will be expected to over-report pain symptoms. This bias cannot be corrected for in the analysis. Contraindications to intra-articular injections: known bleeding disorder/diathesis. Prosthesis in the painful knee. Bilateral total knee replacements. Pregnancy if no recent knee x-rays are available. Wheelchair bound. BMI greater than 40.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 89 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Ultrasound-guided knee CS injection<br>Ultrasound will be used to image knee joint and guide needle for intra-articular knee CS injection. | Procedure: Ultrasound<br>* Ultrasound will be used to image knee joint and guide needle for intra-articular corticosteroid injection.<br>* Other names: Sonosite;|
| Sham Comparator: Sham Ultrasound knee CS injection<br>CS knee injection will be performed in the same method as the US-guided knee injection but the US machine will be turned off. | Procedure: Sham ultrasound<br>* Knee CS injection will be performed in the same method as the US-guided injection except that the US machine will be turned off. Study patient will be unaware of whether US machine is on or off.<br>* Other names: Sonosite;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compare the effectiveness of US-guided vs. sham US CS intra-articular knee injections as measured by a 10-point between groups difference in the Knee injury and Osteoarthritis Outcome score (KOOS). |  | 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compare the effectiveness of US-guided vs. sham US CS knee injections in reducing pain as measured by KOOS. |  | 2, 6, and 8 weeks | 
| Compare the effectiveness of US-guided vs. sham US CS knee injections in improving self-reported lower extremity function. |  | 2, 4, 6, and 8 weeks | 
| Compare the effectiveness of US-guided vs. sham US CS knee injections in reducing the proportion of patients experiencing knee pain. |  | 2, 4, 6, and 8 weeks | 
| Compare the effectiveness of US-guided vs. sham US knee injections in reducing the use of co-therapies (acetaminophen, nonsteroidal anti-inflammatory drugs, and narcotics) |  | 2, 4, 6, and 8 weeks | 
| Examine whether body mass index, presence or absence of chronic widespread pain, radiographic severity, patient expectations, patient satisfaction, and dispositional optimism predict response to CS injections. |  | 2, 4, 6, and 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ultrasound, osteoarthritis, knee, corticosteroids, intra-articular, injections