Comparison of Intraarticular Ketorolac Versus Triamcinolone Acetone Injection in Patients of Knee Osteoarthritis

  • Soban Sarwar Gondal
  • Abeera Zareen
  • Muhammad Haroon Anwar Rawalpindi Medical University
  • Jawad Zaheer
  • Muhammad Salim
Keywords: knee osteoarthritis, ketorolac, triamcinolone.

Abstract

Objective:

            To compare the analgesic and functional outcomes of intra-articular ketorolac with corticosteroids in patients of knee OA.

Methods:

            In this randomized comparative study, we included patients of knee OA who were planned for intra-articular injections from January-2020 to December-2020 in the Department of Anesthesia and Pain Medicine at Rawalpindi Medical University. Patients were allocated to two groups using block randomization, each block contained 30 patients and received injection of either triamcinolone (Group T) or ketorolac (Group K). VAS score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were noted at 1 week, 1 month and at 3 months of injection.

Results:

Mean baseline WOMAC score was 46.60±5.64 in group K and 47.0±5.27 in group T (p-value 0.74). Mean WOMAC score was reduced significantly at 1st week and 1 months and 3 months follow-up in both groups, with insignificant statistical difference in group K and T (p-value 0.39, 0.18 & 0.15 respectively). Baseline VAS score was 7.02±1.34 in group K versus 7.27±1.03 in group T (p-value 0.36). VAS score was also reduced at 1 week, 1 month and 3 months follow-up, however the mean VAS at intervals was not statistically different between group K and T with p-value of 0.13, 0.08 and 0.49 respectively. Treatment was successful in 22 (55%) patients in group K versus 24 (60%) patients in group T (p-value 0.65).

Conclusion:

            Intraarticular ketorolac has similar functional and analgesic outcomes as that of triamcinolone.

References

1. Bortoluzzi A, Furini F, Scirè CA. Osteoarthritis and its management - Epidemiology, nutritional aspects and environmental factors. Autoimmun Rev. 2018;17(11):1097-104.
https://doi.org/10.1016/j.autrev.2018.06.002
2. Nelson AE. Osteoarthritis year in review 2017: clinical. Osteoarthritis Cartilage. 2018;26(3):319-25.
https://doi.org/10.1016/j.joca.2017.11.014
3. Primorac D, Molnar V, Rod E, Jeleč Ž, Čukelj F, Matišić V, et al. Knee Osteoarthritis: A Review of Pathogenesis and State-Of-The-Art Non-Operative Therapeutic Considerations. Genes. 2020;11(8).
https://doi.org/10.3390/genes11080854
4. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26(3):355-69.
https://doi.org/10.1016/j.cger.2010.03.001
5. Lipton RB, Schwedt TJ, Friedman BW. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2017 Jan 5; 388 (10053): 1545–602.
6. Bonnet CS, Walsh DA. Osteoarthritis, angiogenesis and inflammation. Rheumatology (Oxford). 2005;44(1):7-16.
https://doi.org/10.1093/rheumatology/keh344
7. La Hausse de Lalouvière L, Ioannou Y, Fitzgerald M. Neural mechanisms underlying the pain of juvenile idiopathic arthritis. Nat Rev Rheumatol. 2014;10(4):205-11.
8. Khan M, Adili A, Winemaker M, Bhandari M. Management of osteoarthritis of the knee in younger patients. CMAJ. 2018;190(3):E72-e9.
https://doi.org/10.1503/cmaj.170696
9. Chevalier X, Sheehan B, Whittington C, Pourrahmat MM, Duarte L, Ngai W, et al. Efficacy and Safety of Hylan G-F 20 Versus Intra-Articular Corticosteroids in People with Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis. Clin Med Insights Arthritis Musculoskelet Disord. 2020;13:1179544120967370.
https://doi.org/10.1177/1179544120967370
10. Oo WM, Liu X, Hunter DJ. Pharmacodynamics, efficacy, safety and administration of intra-articular therapies for knee osteoarthritis. Expert Opin Drug Metab Toxicol. 2019;15(12):1021-32.
https://doi.org/10.1080/17425255.2019.1691997
11. Migliore A, Anichini S. Intra-articular therapy in hip osteoarthritis. Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases. 2017;14(2):179-81.
https://doi.org/10.11138/ccmbm/2017.14.1.179


12. Hepper CT, Halvorson JJ, Duncan ST, Gregory AJ, Dunn WR, Spindler KP. The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg. 2009;17(10):638-46.
https://doi.org/10.5435/00124635-200910000-00006
13. Matzkin EG, Curry EJ, Kong Q, Rogers MJ, Henry M, Smith EL. Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis. J Am Acad Orthop Surg. 2017;25(10):703-14.
https://doi.org/10.5435/jaaos-d-16-00541
14. Kumar N, Newman RJ. Complications of intra- and peri-articular steroid injections. Br J Gen Pract. 1999;49(443):465-6.
https://bjgp.org/content/49/443/465.short
15. Wernecke C, Braun HJ, Dragoo JL. The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Orthopaedic journal of sports medicine. 2015 Apr 27;3(5):2325967115581163.
https://doi.org/10.1177/2325967115581163
16. Xu J, Qu Y, Li H, Jiang T, Zheng C, Wang B, et al. Effect of ketorolac in intra-articular injection analgesia for postoperative pain in patients undergoing shoulder arthroscopy: a pilot-controlled clinical study. J Pain Res. 2019;12:417-22.
https://doi.org/10.2147/jpr.s178413
17. Shapiro PS, Rohde RS, Froimson MI, Lash RH, Postak P, Greenwald AS. The effect of local corticosteroid or ketorolac exposure on histologic and biomechanical properties of rabbit tendon and cartilage. Hand (New York, NY). 2007;2(4):165-72.
https://doi.org/10.1007/s11552-007-9042-6
18. Xu J, Qu Y, Li H, Zhu A, Jiang T, Chong Z, et al. Effect of Intra-articular Ketorolac Versus Corticosteroid Injection for Knee Osteoarthritis: A Retrospective Comparative Study. Orthopaedic journal of sports medicine. 2020;8(4):2325967120911126.
https://doi.org/10.1177/2325967120911126
19. Jurgensmeier K, Jurgensmeier D, Kunz DE, Fuerst PG, Warth LC, Daines SB. Intra-articular Injections of the Hip and Knee With Triamcinolone vs Ketorolac: A Randomized Controlled Trial. J Arthroplasty. 2021;36(2):416-22.
https://doi.org/10.1016/j.arth.2020.08.036
20. Bellamy JL, Goff BJ, Sayeed SA. Economic Impact of Ketorolac vs Corticosteroid Intra-Articular Knee Injections for Osteoarthritis: A Randomized, Double-Blind, Prospective Study. J Arthroplasty. 2016;31(9 Suppl):293-7.
https://doi.org/10.1016/j.arth.2016.05.015
Published
2021-12-31
How to Cite
1.
Gondal S, Zareen A, Anwar M, Zaheer J, Salim M. Comparison of Intraarticular Ketorolac Versus Triamcinolone Acetone Injection in Patients of Knee Osteoarthritis. JRMC [Internet]. 31Dec.2021 [cited 21Jan.2022];25(4). Available from: https://journalrmc.com/index.php/JRMC/article/view/1750