Common Practices in Intra-Articular Corticosteroid Injection for the Treatment of Knee Osteoarthritis: A Survey of the American Association of Hip and Knee Surgeons Membership

Knee osteoarthritis nonoperative management options remain limited. Our aim is to define the current American Association of Hip and Knee Surgeons (AAHKS) members’ practices and perceptions in terms of the frequency, formulation, use of concomitant aspiration, maximum lifetime number of injections, efficacy, interval between injection and surgery and complication rates.

A 22-question survey based on Likert scale response anchors was approved and distributed by the AAHKS Research Committee to its membership by email during the Spring 2019 meeting. Data were managed with REDCap software.

Membership response totaled 537 of 2365 (22.7%) members. Highlights include every respondent using intra-articular corticosteroid injections (ICIs) in their practice, and most use a three-month minimum interval, although the preferred interval is longer. Near consensus was found waiting three months before surgery. There was a great variability in the number of injections allowed, and injections before surgery were very common. Nearly all responders use a local anesthetic mixture with the cortisone injection, but there was great variation in corticosteroid type: methylprednisolone (42%), triamcinolone (41%), betamethasone (13.3%), and dexamethasone (3.7%).

The results of our survey indicate the majority of the AAHKS members who completed the survey use ICIs routinely for treatment of knee osteoarthritis. There was near consensus in ICIs, which is effective with decreasing efficacy over serial injections, and an absolute minimum interval between injections was believed by most to be three months with no clearly defined lifetime limit and strong consensus for a three-month preoperative interval. The formulation of steroid, local anesthetic, and skin preparation technique varied greatly.