Spitzer Andrew I, Mont Michael A, Lin Jennifer H, Dasa Vinod, Rivadeneyra Adam, Rogenmoser David, Concoff Andrew L, Ng Mitchell K, DiGiorgi Mary, Dysart Stan, Urban Joshua, Mihalko William M
Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California.
Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland.
Surg Technol Int. 2025 Mar 21;45.
There is a wide range of nonoperative options to manage symptomatic knee osteoarthritis (OA). This paper aimed to 1) define the treatment sequence for patients undergoing up to four subsequent rounds (i.e., cryoneurolysis) of superficial (Cryo-Superficial) and/or deep genicular nerves (Cryo-Deep/Both), intra-articular corticosteroid injections (IA-CS), triamcinolone extended-release (IA-TA-ER), hyaluronic acid (IA-HA), or non-steroidal anti-inflammatory drugs (IA-NSAIDs); 2) compare usage of extended-release versus standard corticosteroid injections; and 3) quantify distribution of repeated treatments.
We identified 502 patients with symptomatic knee OA and received nonoperative intervention within the Innovations in Genicular Outcomes (IGOR) registry from 2021 to 2024. Treatment journey during follow up was presented aggregating baseline patient demographics, along with sequence of nonoperative treatments per patient, duration, and frequency of repeated use. Repeated use of Round 1 treatment for subsequent treatment rounds was estimated with descriptive statistics.
Fifty-three percent of patients received only the original Round 1 treatment option, either single/repeated dose and did not receive any alternative treatment. Seventy-three percent of patients treated with intra-articular extended-release triamcinolone (IA-TAER) repeated the treatment at least once, whereas 60% of those treated with other treatments did so. No adverse events were reported in patients during repeated treatments.
Patients who received IA-TAER were more likely to repeat the same injection, with 73% repeating at least once and no adverse events were attributed to repeated injections. Approximately half of the patients have switched from the initial treatment offered during follow up, with the use of IA-TAER associated with higher rates of repeated treatment. Significance and Innovation 1. Our study used a newly developed real-world registry IGOR to characterize treatment progression for patients with symptomatic knee OA undergoing up to five rounds of nonoperative treatment. 2. Non-surgical interventions included cryoneurolysis, intra-articular injections of NSAIDs, hyaluronic acid injections, corticosteroid, or extended release steroid (triamcinolone) injections. 3. We found 73% of patients treated with intra-articular extended-release steroid injections repeated treatment at least once, relative to 60% by other treatments. 4. We found approximately half of patients switched from initial treatment offered during follow up, with the use of IA-TAER associated with higher rates of repeated treatment.
有多种非手术方法可用于治疗症状性膝关节骨关节炎（OA）。本文旨在：1）确定接受多达四轮后续治疗（即冷冻神经lysis）的患者的治疗顺序，治疗包括浅表（Cryo-浅表）和/或膝下深神经（Cryo-深部/两者）、关节内皮质类固醇注射（IA-CS）、曲安奈德缓释注射（IA-TA-ER）、透明质酸（IA-HA）或非甾体抗炎药（IA-NSAIDs）；2）比较缓释与标准皮质类固醇注射的使用情况；3）量化重复治疗的分布情况。
我们确定了502例有症状的膝关节OA患者，他们在2021年至2024年期间在膝关节结局创新（IGOR）登记处接受了非手术干预。随访期间的治疗过程呈现了汇总的基线患者人口统计学数据，以及每位患者的非手术治疗顺序、持续时间和重复使用频率。使用描述性统计方法估计后续治疗轮次对第一轮治疗的重复使用情况。
53%的患者仅接受了最初的第一轮治疗选项，单次/重复剂量，未接受任何替代治疗。接受关节内曲安奈德缓释注射（IA-TAER）治疗的患者中有73%至少重复治疗了一次，而接受其他治疗的患者中这一比例为60%。重复治疗期间患者未报告不良事件。
接受IA-TAER治疗的患者更有可能重复相同的注射，73%的患者至少重复一次，且未发现重复注射导致不良事件。约一半的患者在随访期间从最初提供的治疗方案转换，IA-TAER的使用与更高的重复治疗率相关。意义与创新：1. 我们的研究使用了新开发的真实世界登记处IGOR来描述有症状的膝关节OA患者接受多达五轮非手术治疗的治疗进展。2. 非手术干预包括冷冻神经lysis、关节内注射NSAIDs、透明质酸注射、皮质类固醇或缓释类固醇（曲安奈德）注射。3. 我们发现接受关节内缓释类固醇注射治疗的患者中有73%至少重复治疗一次，而其他治疗方法为60%。4. 我们发现约一半的患者在随访期间从最初提供的治疗方案转换，IA-TAER的使用与更高的重复治疗率相关。
