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Knee Surg Sports Traumatol Arthrosc. 2023 Feb;31(2):426-431. doi: 10.1007/s00167-022-07017-z. Epub 2022 Jun 30.
Intra-articular corticosteroid injections (CSI) are used commonly for the non-operative management of patients with knee pain. Recent literature has raised concern for chondrotoxicity of CSI. The purpose of the present study is to evaluate for any dose-dependent association between CSI in non-osteoarthritic knees and subsequent total knee arthroplasty (TKA).
The Pearl Diver database identified patients with a diagnosis of knee pain without concomitant osteoarthritis who were administered CSI over a 2-year period. Patients were compared to matched and unmatched cohorts. The primary endpoint was the incidence of TKA at 5 years. Multivariable regression analysis was used to assess CSI quantity as an independent risk factor.
49,443 of 986,162 (5.0%) Patients diagnosed with knee pain without concomitant knee osteoarthritis who received at least one CSI were identified. At 5 years, there was a higher incidence of TKA in the matched injection cohort relative to the non-injection matched cohort (0.26 vs 0.13%; p < 0.001) and unmatched cohort (0.26 vs. 0.10%, p < 0.001). The quantity of CSI corresponded with an increased probability of TKA at 5 years; one injection: 0.22% (OR 1.23, 95% CI [0.87-1.74], p = 0.236); two injections: 0.39% (OR 1.98 CI [1.06-3.67], p = 0.03, three or more injections: 0.49% (OR 3.22 CI [1.60-6.48], p = 0.001). The average time to TKA after one CSI was 3.03 ± 2.29 years. This time was nearly halved with three CSI (1.78 ± 0.80 years, p < 0.001).
Intra-articular corticosteroid injections in patients without knee osteoarthritis at the time of injection are associated with a dose-dependent risk of TKA at 5 years. CSI may not be as benign of a treatment modality as previously thought.
关节内皮质类固醇注射（CSI）常用于膝关节疼痛患者的非手术治疗。最近的文献引起了人们对 CSI 软骨毒性的关注。本研究的目的是评估非骨关节炎膝关节中 CSI 与随后全膝关节置换术（TKA）之间是否存在任何剂量依赖性关联。
Pearl Diver 数据库确定了在两年期间接受过膝关节疼痛诊断但无伴随骨关节炎的 CSI 治疗的患者。将这些患者与匹配和不匹配的队列进行比较。主要终点是 5 年内 TKA 的发生率。多变量回归分析用于评估 CSI 量作为独立的危险因素。
在 986162 名被诊断为膝关节疼痛且无膝关节骨关节炎的患者中，有 49443 名（5.0%）至少接受过一次 CSI。5 年内，与未接受 CSI 的匹配对照组相比，接受 CSI 的匹配注射组（0.26 比 0.13%；p<0.001）和不匹配组（0.26 比 0.10%；p<0.001）TKA 的发生率更高。CSI 的数量与 5 年内 TKA 的发生概率呈正相关；一次注射：0.22%（OR 1.23，95%CI [0.87-1.74]，p=0.236）；两次注射：0.39%（OR 1.98 CI [1.06-3.67]，p=0.03）；三次或更多注射：0.49%（OR 3.22 CI [1.60-6.48]，p=0.001）。接受一次 CSI 后发生 TKA 的平均时间为 3.03±2.29 年。接受三次 CSI 后，这一时间几乎缩短了一半（1.78±0.80 年，p<0.001）。
在接受注射时没有膝关节骨关节炎的患者中，关节内皮质类固醇注射与 5 年内 TKA 的剂量依赖性风险相关。CSI 可能不像以前认为的那样是一种良性治疗方式。
