Evidence-Based Knee Injections for the Management of Arthritis

Cheng, Olivia; Souzdalnitski, Dmitri; Vrooman, Bruce; Cheng, Jianguo

doi:10.1111/j.1526-4637.2012.01394.x

Cited by 141 publications

(106 citation statements)

References 82 publications

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“…In the conservative treatment of osteoarthritisrelated chronic knee pain, analgesics, physical therapy, intra-articular steroids, opioid, nonsteroidal antiinflammatory drugs (NSAIDs), local anesthetic, and viscosupplementation are applied (3)(4)(5)(6). The use of NSAIDs as pharmacological treatment is limited because of serious side effects such as gastro-intestinal ulcers and bleeding.…”

Section: Introductionmentioning

confidence: 99%

The genicular nerve: radiofrequency lesion application for chronic knee pain*

Kirdemi̇r¹,

Çatav²,

Solmaz³

2017

Turk J Med Sci

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Background/aim: We investigated the short-and medium-term effectiveness of genicular nerve radiofrequency (RF) applied in patients with chronic knee pain due to osteoarthritis. Materials and methods:Radiofrequency was performed in 49 patients with a diagnosis of knee osteoarthritis. VAS and WOMAC were measured at baseline and at 1, 4, and 12 weeks postprocedure. Under fluoroscopic guidance, the cannula was advanced percutaneously towards the area connecting the shaft to the epicondyle. The RF electrode was inserted through the cannula and the electrode tip temperature was raised to 80 °C for 90 s. One RF lesion was made for each genicular nerve.

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Section: Introductionmentioning

confidence: 99%

The genicular nerve: radiofrequency lesion application for chronic knee pain*

Kirdemi̇r¹,

Çatav²,

Solmaz³

2017

Turk J Med Sci

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“…Conservative approaches include physical therapy, analgesic drugs, intra-articular injection of steroids, and visco-supplementation [3,4]. Pharmacological therapy is often of limited benefit for OA pain, but non-steroidal anti-inflammatory drugs are associated with serious side effects, such as bleeding and gastrointestinal ulcers.…”

mentioning

confidence: 99%

Cooled radiofrequency system relieves chronic knee osteoarthritis pain: the first case-series

Bellini¹,

Barbieri²

2015

Anaesthesiol Intensive Ther

100

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Background: Knee osteoarthritis is a frequent cause of chronic knee pain. Therapeutic solutions include intra-articular injections with short-term pain relief and surgical therapy. Radiofrequency (RF) of genicular nerves has been previously reported with varying success. Cooling tissue adjacent to the electrode (cooled RF) increases the radius of lesion. We present here the first retrospective data on pain relief and changes in function after such cooled RF denervation. Methods: We reviewed the records of nine patients with chronic knee pain who underwent cooled RF of genicular nerves. Visual analogue scale (VAS) and Western Ontario McMaster Universities OA index (WOMAC) were analysed. Results: We observed an improvement in VAS pain scores 2 ± 0.5 at one month, 2.3 ± 0.7 at three months, 2.1 ± 0.5 at six months, and 2.2 ± 0.2 at 12 months after the procedure, and WOMAC score 20 ± 2, at one month, 22 ± 0.5 at three months, 21 ± 1.7 at six months, and 20 ± 1.0 at 12 months. Conclusion:The majority of patients with chronic knee pain experienced a clinically relevant degree of pain relief and improved function following cooled RF of genicular nerves at one, three, six and 12 months follow-up.

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“…18 A recent study found that injections with hyaluronic acid were costly and had limited clinical benefit. 18 Similarly, intra-articular injection of corticosteroids, which may be offered for pain relief in osteoarthritis patients, 16 was also rejected by the MSAC for public funding in 2011. 19 Arthroscopic debridement to remove debris from around the knee joint may also be offered, however, there is a large body of evidence that demonstrates that arthroscopy offers no benefit in terms of improvement of pain and function in patients with osteoarthritis.…”

Section: The Comparatormentioning

confidence: 99%

“…15 Although some studies demonstrated a positive benefit with hyaluronic acid injection, recent studies have reported the same level of pain reduction after injection with hyaluronic acid as placebo. 16 Viscosupplementation with hyaluronic acid was rejected for public funding by the MSAC in 2003 due to a lack of evidence. 17 This position has been vindicated by a recent statement by the American Academy of Orthopedic Surgeons that the treatment of patients with severe knee osteoarthritis with hyaluronic acid could not be recommended 'based on high-quality evidence that hyaluronic acid injections were not associated with clinically meaningful improvement in symptoms compared with placebo injections.'…”

Section: The Comparatormentioning

confidence: 99%

Platelet-rich plasma: a case study for the identification of disinvestment opportunities using horizon scanning

Mundy

2017

Aust. Health Review

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Objective. This paper discusses the potential for horizon scanning to identify low-value, inappropriate clinical practices that deliver minimal benefit to patients and represent a considerable financial burden on the health system.Methods. Platelet-rich plasma (PRP) was identified by routine horizon scanning as a potentially innovative treatment alternative for osteoarthritis of the knee. A rapid, non-systematic assessment of the evidence pertaining to the safety and effectiveness of PRP compared with nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of osteoarthritis of the knee was conducted.Results. The evidence base supporting the use of PRP for the treatment of osteoarthritis was poor. No comparative studies were identified that compared the use of PRP to NSAIDs, the current treatment option for osteoarthritis of the knee in Australia. Despite the lack of effectiveness evidence, the use of PRP injections was rapidly increasing in the private sector using an inappropriate Medicare Benefits Schedule item number.Conclusions. This assessment highlights the potential of using established horizon scanning methodologies to identify targets for full or partial disinvestment of ineffective, inefficient or harmful clinical practices.What is known about the topic? PRP is rapidly diffusing in the private health system in Australia, however the use of a Medicare Benefits Schedule item number meant that this practice was being subsidised by the public reimbursement of treatment fees. What does this paper add? Traditional horizon scanning tends to identify technologies for health systems to invest in. The evidence on the effectiveness of PRP was examined with the purpose of exploring investment in an innovative treatment that may have reduced the number of invasive procedures being performed in the public hospital system. The current evidence base does not support the use of PRP injections for the treatment of osteoarthritis. It does, however, support the use of horizon scanning as an inexpensive methodology to identify possible disinvestment targets associated with potential patient harm and high health service expenditure. What are the implications for practitioners? Practitioners should be aware that public funding for the injection of PRP should not be used for the treatment of osteoarthritis.

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Evidence-Based Knee Injections for the Management of Arthritis

Cited by 141 publications

References 82 publications

The genicular nerve: radiofrequency lesion application for chronic knee pain*

The genicular nerve: radiofrequency lesion application for chronic knee pain*

Cooled radiofrequency system relieves chronic knee osteoarthritis pain: the first case-series

Platelet-rich plasma: a case study for the identification of disinvestment opportunities using horizon scanning

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