Review
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World J Orthop. Jul 18, 2014; 5(3): 351-361
Published online Jul 18, 2014. doi: 10.5312/wjo.v5.i3.351
Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis
Egemen Ayhan, Hayrettin Kesmezacar, Isik Akgun
Egemen Ayhan, Department of Orthopaedics and Traumatology, Mersin University, Mersin 33110, Turkey
Hayrettin Kesmezacar, Isik Akgun, Kaktus Health Center, Istanbul 34394, Turkey
Author contributions: Ayhan E, Kesmezacar H and Akgun I contributed to this paper for conception and design, acquisition of data, and interpretation of data, drafting the article and revising it critically for important intellectual content, and final approval of the version to be published.
Correspondence to: Egemen Ayhan, MD, Department of Orthopaedics and Traumatology, Mersin University, Mersin 33110, Turkey. egemenay@yahoo.com
Telephone: +90-532-6363693 Fax: +90-324-3374305
Received: December 29, 2013
Revised: March 9, 2014
Accepted: May 31, 2014
Published online: July 18, 2014
Abstract

Osteoarthritis (OA) is a complex “whole joint” disease pursued by inflammatory mediators, rather than purely a process of “wear and tear”. Besides cartilage degradation, synovitis, subchondral bone remodeling, degeneration of ligaments and menisci, and hypertrophy of the joint capsule take parts in the pathogenesis. Pain is the hallmark symptom of OA, but the extent to which structural pathology in OA contributes to the pain experience is still not well known. For the knee OA, intraarticular (IA) injection (corticosteroids, viscosupplements, blood-derived products) is preferred as the last nonoperative modality, if the other conservative treatment modalities are ineffective. IA corticosteroid injections provide short term reduction in OA pain and can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with OA. IA hyaluronic acid (HA) injections might have efficacy and might provide pain reduction in mild OA of knee up to 24 wk. But for HA injections, the cost-effectiveness is an important concern that patients must be informed about the efficacy of these preparations. Although more high-quality evidence is needed, recent studies indicate that IA platelet rich plasma injections are promising for relieving pain, improving knee function and quality of life, especially in younger patients, and in mild OA cases. The current literature and our experience indicate that IA injections are safe and have positive effects for patient satisfaction. But, there is no data that any of the IA injections will cause osteophytes to regress or cartilage and meniscus to regenerate in patients with substantial and irreversible bone and cartilage damage.

Keywords: Intraarticular injections, Corticosteroid, Hyaluronic acid, Platelet rich plasma, Knee osteoarthritis, Viscosupplementation

Core tip: Intraarticular (IA) corticosteroid injections can be considered as an adjunct to core treatment for short term reduction of moderate to severe pain in people with osteoarthritis (OA). IA hyaluronic acid (HA) injections might have efficacy and might provide pain reduction in mild OA of knee up to 24 wk. But for HA injections, the cost-effectiveness is an important concern that patients must be informed. Although more high-quality evidence is needed, recent studies indicate that IA platelet rich plasma injections are promising for relieving pain, improving knee function and quality of life, especially in younger patients, and in mild OA cases.