Joint injections in Humans. Evidence and Experience with steroids, HA and other preparates

For knee osteoarthritis (OA), intraarticular (IA) injections (corticosteroids, viscosupplements, radioisotope and blood-derived products) are the preferred nonoperative treatment methods, if other conservative treatment options are ineffective. This presentation addresses the intraarticular injections routinely administered in our department. IA corticosteroid injections promise short-term pain relief for up to 3 weeks post injection. IA hyaluronic acid (HA) injections are also used to reduce osteoarthritic pain and improve joint function by supplementing the synovial fluid with exogenous HA (“viscosupplementation”) to provide lubrication and mechanical support. Several small, randomized trials and our experience have shown, that the combination of a corticosteroid and HA versus HA alone results in a more significant short-term pain relief due to the corticosteroid and a prolonged long-term pain relief due to the HA. In chronic synovitis radiosynovectomy can also be an effective treatment, as it removes the inflamed synovial tissue from the affected joint. Although more clinical evidence is needed, biological- therapies, such as plateled rich plasma (PRP), bone marrow aspirate concentrate (BMAC) and adipose-derived stem cell (ADSC), have also gained popularity for the treatment of cartilage damage in the last decade. These treatment options are likely to have the greatest therapeutic potential for focal chondral defects and possibly for early OA.

The current literature and our experience indicate that IA injections are safe and have positive effects on patient satisfaction. But, up to this moment, there is no data to suggest, that any of the IA injections would cause osteophytes to regress or cartilage and meniscus to regenerate in patients with substantial and irreversible bone and cartilage damage.