A recent cohort study suggested a three-fold higher risk for knee osteoarthritis (OA) progression with the use of corticosteroid (CS) injections. Recipients of CS injections might have more advanced knee OA, which in itself is a risk factor for OA progression, making a comparison of those undergoing CS injections to those who do not report injections questionable, despite statistical adjustments. Therefore, researchers aimed to explore whether CS injections are associated with increased rates of knee OA progression compared with hyaluronic acid injections that have not been associated with cartilage loss. The study team used data from two large cohort studies of people with knee OA who received either corticosteroid or hyaluronic acid injections and reviewed the rates of radiographic progression and total knee replacement surgery. The rate of total knee replacement surgery was greater among patients with a single exam in which they reported hyaluronic acid injection compared with those with a single exam in which they reported CS injection. There was no difference between patients reporting injections at multiple exams. Multivariable analysis showed similar rates of X-ray progression for both kinds of injection treatment at either single or multiple medical exams. The authors concluded that CS injections for knee OA were not associated with a higher rate of radiographic progression or progression to a total knee replacement compared with hyaluronic acid injections.
