[ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS] 11/21/2017 1 Knee Injections for Osteoarthritis Brian Feeley, MD Sports Medicine and Shoulder Surgery UC San Francisco Outline Indications for Injections/Aspirations Injectable medications Outcomes (covered previously) How to do a knee injection easily
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Knee Injections for Osteoarthritis - ucsfcme.com Injections for Osteoarthritis ... Treatment of Osteoarthritis of the Knee Evidence-Based Guideline 2nd Edition ... Microsoft PowerPoint
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• Send for cell count, differential, crystals +/- gram stain and culture
Therapeutic
• Osteoarthritis
• Crystal arthropathy
• Inflammatory arthritis
Case 1
42 year old male, BMI 38, comes in with a 3 day history of increased right knee pain and swelling. He thinks he might have had a fall a week ago, but doesn’t remember pain. He has bought a cane and presents with a noticeable limp and large effusion.
• On exam, he has a moderately red joint, and cannot straighten past 10 degrees
55 year old computer scientist with 3 weeks of knee pain and swelling. He has a history of 2 meniscus debridements, and was told he had some mild arthritis 5 years ago at his last surgery. He has a trip in 2 weeks to Istanbul (not Constantinople) and wants to feel good for the trip, so is asking for an injection (also he has a lot of questions).
Intraarticular corticosteroid for knee OA: American Academy of OrthopaedicSurgeons 2013
Treatment of Osteoarthritis of the Knee Evidence-Based Guideline 2nd EditionAmerican Academy of Orthopaedic Surgeons 2013.www.aaos.org/research/guidelines/TreatmentofOsteoarthritisoftheKneeGuideline.pdf. Accessed 11/13/15.
Appropriate treatment
Quality of evidence: Good
Clinically significant short-term pain relief
Consider other options for longer duration pain relief
Intraarticular corticosteroid for knee OA: Osteoarthritis Research Society International 2014
McAlindon TE et al. OARSI Guidelines for the Non-Surgical Management of Knee Osteoarthritis. Osteoarthritis and Cartilage 2014.
62 year old male presents with progressive knee pain and a known history of arthritis. He has had NSAIDS, PT, and steroid injections. The last 3 steroid injections haven’t worked as well and he would like to try something different but doesn’t feel ready for surgery.
“The experts achieved unanimous agreement in favor of the following statements: VS is an effective treatment for mild to moderate knee OA; VS is not an alternative to surgery in advanced hip OA; VS is a well-tolerated treatment of knee and other joints OA”
$500-$1800 per treatment (often recommended to have 3 treatments)No studies have shown marked improvementsNo change in natural historyVery few studies show significant complications