Effects of joint lavage and steroid injection in patients with osteoarthritis of the knee - Results of a multicenter, randomized, controlled trial

Objective. To evaluate the efficacy of joint lavage and intraarticular ster oid injection, alone and in combination, in the treatment of patients with symptomatic knee osteoarthritis (OA). Methods. Ninety-eight patients with painful tibiofemoral OA were enrolled i n a prospective, randomized, controlled, 2 x 2 factorial-design trial of 6 months' duration. The 4 treatment groups consisted of 1) intraarticular pla cebo (1.5 ml of 0.9% normal saline), 2) intraarticular corticosteroids (3.7 5 mg of cortivazol in 1.5 mi), 3) joint lavage and intraarticular placebo, and 4) joint lavage and intraarticular corticosteroid, Outcome measures eva luated at baseline, week 1, week 4, week 12, and week 24 included severity of pain (100-mm visual analog scale [VAS]), global status (100-mm VAS), and Lequesne's functional index. Results. No interaction between steroid injection and joint lavage was demo nstrated. Patients who had undergone joint lavage had significantly improve d pain VAS scores at week 24 (P = 0.020). In contrast, corticosteroid injec tion had no long-term effect (P = 0.313); corticosteroid injection was asso ciated with a decrease in pain only at week 1 (P = 0.003) and week 4 (P = 0 .020). After week 4, Lequesne's functional index was not significantly impr oved regardless of the assigned treatment. Conclusion, Compared with placebo, both treatments significantly relieved p ain but did not improve functional impairment. The effects of the 2 treatme nts were additive. Cortivazol provided short-term relief of pain (up to wee k 4). The effects of joint lavage persisted up to week 24.