Mont Michael A, Lin Jennifer H, Spitzer Andrew I, Dasa Vinod, Rivadeneyra Adam, Rogenmoser David, Concoff Andrew L, Ng Mitchell K, DiGiorgi Mary, DySart Stan, Urban Joshua, Mihalko William M
Sinai Hospital of Baltimore, Baltimore, MD, USA.
Pacira BioSciences, Inc, Tampa, FL, USA.
Arthroplast Today. 2025 Mar 1;32:101655. doi: 10.1016/j.artd.2025.101655. eCollection 2025 Apr.
Since the mid-20th century, knee osteoarthritis (OA) has doubled in prevalence, costing more than $27 billion annually. This study aimed to compare 6 nonoperative treatment options for knee OA (cryoneurolysis with superficial nerve block, cryoneurolysis with deep nerve block, intra-articular hyaluronic acid injections, nonsteroidal inflammatory drug injections, IA corticosteroids, and IA triamcinolone extended release [IA-TA-ER]) over 4 months, analyzing their effects on sleep disturbance, a component of health-related quality of life.
All patients with knee OA and received nonoperative interventions with at least 4 months of follow-up between 2021 and 2024 were identified from the Innovations in Genicular Outcomes Research registry, a multicenter novel real-world registry. Patient demographics were gathered/analyzed, adjusting for age, sex, study site, Kellgren-Lawrence grade, baseline score of pain severity/function, pain-catastrophizing, and analgesic use in each assessment. Sleep disturbance was assessed via least-square-means relative to the average population, with multivariate linear regressions used to assess changes pretherapy/post-therapy.
Patients administered IA-TA-ER had decreased sleep disturbance relative to other cohorts (least-square-means 52.3; 95% confidence interval: 50.5-54.0; < .03). Patients receiving IA-TA-ER or IA corticosteroids achieved achieving minimum clinically important difference for sleep disturbance improvement, 63% and 57%, respectively. Pairwise comparison revealed patients receiving IA-TA-ER were 2 times more likely to achieve minimally clinically important difference for improved sleep relative to other cohorts ( < .05).
Extended-release triamcinolone injections are associated with decreased sleep disturbance relative to other treatments, in both degree of improvement and proportion of patients. Further studies should examine the potential beneficial effects of IA-TA-ER on other aspects of health-related quality of life.
自20世纪中叶以来，膝关节骨关节炎（OA）的患病率翻了一番，每年花费超过270亿美元。本研究旨在比较膝关节OA的6种非手术治疗方案（浅表神经阻滞冷冻神经lysis、深部神经阻滞冷冻神经lysis、关节内透明质酸注射、非甾体抗炎药注射、关节内皮质类固醇和关节内长效曲安奈德[IA-TA-ER]）在4个月内的效果，分析它们对睡眠障碍（健康相关生活质量的一个组成部分）的影响。
从多中心新型真实世界登记处——膝关节结局研究创新登记处识别出2021年至2024年间所有接受非手术干预且至少随访4个月的膝关节OA患者。收集/分析患者人口统计学数据，在每次评估中对年龄、性别、研究地点、凯尔格伦-劳伦斯分级、疼痛严重程度/功能的基线评分、疼痛灾难化和镇痛药物使用情况进行调整。通过相对于普通人群的最小二乘均值评估睡眠障碍，使用多变量线性回归评估治疗前/治疗后的变化。
与其他队列相比，接受IA-TA-ER治疗的患者睡眠障碍有所减轻（最小二乘均值52.3；95%置信区间：50.5-54.0；P<0.03）。接受IA-TA-ER或关节内皮质类固醇治疗的患者在睡眠障碍改善方面分别达到了最小临床重要差异，分别为63%和57%。成对比较显示，与其他队列相比，接受IA-TA-ER治疗的患者睡眠改善达到最小临床重要差异的可能性高出2倍（P<0.05）。
与其他治疗方法相比，长效曲安奈德注射在改善程度和患者比例方面均与睡眠障碍减轻相关。进一步的研究应检查IA-TA-ER对健康相关生活质量其他方面的潜在有益影响。
