Journal article
Effect of intra-articular corticosteroid injections for knee osteoarthritis on the rates of subsequent knee replacement and post-operative outcomes: a national cohort study of England
- Abstract:
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Background: Intra‑articular corticosteroid injection (IACI) is an established treatment option for uncontrolled pain in osteoarthritis. There is a lack of longer‑term follow‑up in most studies of the effects of IACI, meaning there is scarcity of data on the impact of IACI on the subsequent need for joint replacement. Our aim was to assess the effect of IACI for knee osteoarthritis on the subsequent incidence of knee replacement surgery and on associated post‑operative outcomes.
Methods: We conducted a cohort study of knee osteoarthritis patients registered in the Clinical Practice Research Datalink (CPRD) GOLD database with an incident diagnosis between 2005 and 2019. Exposure was single or repeated IACI use, analysed separately. The primary outcome was knee replacement during 1‑year and 5‑year follow‑ups. Secondary outcomes included post‑operative patient‑reported outcome measures and adverse events. Primary analyses used general practitioner practice preference for IACI as an instrumental variable given this methodology can account for strong and unmeasured confounding. Secondary analyses used propensity score matching, accounting for measured covariates only.
Results: During 1‑year follow‑up, 1628/33,357 (4.9%) knee osteoarthritis patients underwent knee replacement, for which single IACI was associated with lower risk, which persisted to 5‑year follow‑up (incidence rate ratio: 0.52 [0.36, 0.77]). Conversely, in secondary propensity score analyses no association was found between IACI use and knee replacement rate at 1‑year follow‑up, and an estimated increased rate of knee replacement at 5‑year follow‑up. Use of IACI pre‑joint replacement was not associated with any adverse post‑operative outcomes, for example, 1‑year complication rates (per 100 person‑years) following knee replacement were 4.6 (3.8, 5.8), 4.0 (2.7, 6.0) and 5.0 (3.1, 8.1) among patients with no, single and repeat pre‑joint replacement IACI use, respectively.
Conclusions: Findings from our main analysis suggest that short‑term pain reduction following IACI for knee osteoarthritis may translate to lower rates of knee replacement over 5 years follow‑up, although contradictory associations were observed in secondary analyses which likely reflected residual confounding by indication. Reassuringly, IACI use before knee replacement was not associated with post‑operative adverse outcomes.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 2.7MB, Terms of use)
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- Publisher copy:
- 10.1186/s12916-025-04000-6
Authors
- Publisher:
- BioMed Central
- Journal:
- BMC Medicine More from this journal
- Volume:
- 23
- Issue:
- 1
- Article number:
- 195
- Publication date:
- 2025-04-07
- Acceptance date:
- 2025-03-12
- DOI:
- EISSN:
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1741-7015
- Language:
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English
- Keywords:
- Pubs id:
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2093718
- Local pid:
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pubs:2093718
- Deposit date:
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2025-03-13
- ARK identifier:
Terms of use
- Copyright holder:
- Hawley et al
- Copyright date:
- 2025
- Rights statement:
- © The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
- Licence:
- CC Attribution (CC BY)
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