Adding triamcinolone improves viscosupplementation: a randomized clinical trial

Abstract

Background: Intraarticular injections, mainly using long-lasting corticosteroid suspensions, have long been used to treat knee osteoarthritis. Viscosupplementation is a relatively new approach with injection of a variety of agents. When comparing viscosupplementation with intraarticular injections of corticosteroids from baseline to the fourth week, steroids have been more effective for pain relief. By the fourth week they provide similar relief, but beyond that viscosupplementation appears to provide greater pain reduction. The delayed onset of symptomatic improvement combined with reports of reactive synovitis may discourage physicians and patients.

Questions/purposes: We therefore addressed three questions: Does the addition of triamcinolone to viscosupplementation (1) improve first-week pain and function compared with viscosupplementation alone, (2) diminish adverse effects of viscosupplementation alone, and (3) alter 6-month pain and function of viscosupplementation alone?

Methods: We prospectively enrolled 104 patients with knee osteoarthritis and randomized them to receive either a single intraarticular injection (6 mL) of hylan GF-20 (Group viscosupplementation [Group VS]), or a single intraarticular injection of hylan GF-20 (6 mL) and 1 mL (20 mg) of triamcinolone hexacetonide (Group VS + T). VAS, WOMAC™, and Lequesne questionnaires were completed at baseline and at Weeks 1, 4, 12, and 24.

Results: At Week 1 the WOMAC and VAS scores were lower in Group VS + T, compared with Group VS. There was no difference regarding the adverse effects. At Weeks 4, 12, and 24 there were no differences in the groups.

Conclusions: The addition of triamcinolone hexacetonide improves first-week symptom and functional scores of viscosupplementation, but not beyond. It does not seem to increase the likelihood of adverse effects.

Level of evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

The flow of our study is shown in this diagram.

Fig. 2A–D

The graphs show the mean results with respective standard errors for (A) WOMAC™, (B) WOMAC™ pain subscale, (C) VAS, and (D) Lequesne index. At Week 1, there are differences in WOMAC™ (p = 0.038) and VAS (p = 0.014) favoring Group VS + T. P values on the graph relate only to differences between the scores at followup and baseline, not differences in scores between the groups.