Intra-articular Injection of Local Anaesthetic and Corticosteroid: A Potentiation Effect of Pain Relief in Grade IV Gonarthrosis and an Alternative to Arthroplasty Operations

Abstract

Background and Aim: There are few nonsurgical options for treatment of grade IV knee osteoarthritis. This randomised controlled clinical trial was performed to evaluate the efficacy and safety of intra-articular injection of local anaesthetic and corticosteroid for pain management in patients with grade IV osteoarthritic knee joints. Methods: A total of 240 patients with grade IV osteoarthritic knee joints were enrolled and separated into four groups. They were administered different intra-articular injections: Group A received local anaesthetic (prilocaine); Group B received methylprednisolone; Group C received methylprednisolone+ saline; and Group D received methylprednisolone+prilocaine. The number of pain-free days following injection was recorded. Results: The mean number of pain-free days was 3.7±0.2days in Group A vs.62.1±0.3 days in Group B vs. 75.5±0.8 days in Group C vs. 157±0.5 days in Group D (P<0.05). Patients were asked to report to the clinic if pain recurred and the same injection was repeated. After the second injection, once again, the number of pain-free days was significantly higher in Group D (161 days) than in the other groups. Adverse events encountered included syncope (n=14) and cellulitis at injection site (n=2). Conclusion: Intra-articular combination of methylprednisolone and prilocaine appears to be a safe and effective method for potentiating pain relief in grade IV knee osteoarthritis. The injection can be repeated at intervals to provide a permanent pain-free knee for patients.