SLR - January 2023 - Amir Pouria Alikhani-Koopaei
Title: Outcome of intra-articular corticosteroid vs. intra-articular ketorolac in symptomatic knee osteo-arthritis: a retrospective studyReference: Verma V, Kunwar A, Yadav A, Verma S. Outcome of intra-articular corticosteroid vs. intra-articular ketorolac in symptomatic knee osteo-arthritis: a retrospective study. Int Surg J 2022 Mar;9(3):639-43.
Level of Evidence: Level 3 evidence
Scientific Literature Review
Reviewed By: Amir Pouria Alikhani-Koopaei
Residency Program: LECOM Health/Millcreek Community Hospital (Erie, Pennsylvania)
Podiatric Relevance: This article is interesting to Podiatric Medicine and Surgery because we need more non-surgical options in clinic for management of Osteoarthritis. I believe adjunct to intraarticular corticosteroid injection; patients can receive intraarticular ketorolac injections to prolong the need for surgery.
Methods: The study is a case-control, retrospective comparative study. The study included a total of 50 patients (30 females and 20 males) with symptomatic knee osteo-arthritis, age ranging from 45 to 75 years. All patients received, 4 weekly injections. Triamcinolone or ketorolac was given for the first three weeks and on the 4th week, only intra-articular sodium hyaluronate injections were given. Patient parameters were assessed by the pain visual analog scale (VAS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). All the parameters (VAS, WOMAC) were evaluated and recorded at the 1st, 2nd, and 5th weeks, and then again at the 3 months after first injection.
Results: The article has some interesting results. At the last follow-up, no significant differences were found in the successful treatment rate between these 2 groups. The Pain findings found the mean VAS pain scores of both groups decreased significantly from baseline to each follow-up time point. At the first week, the VAS score was lower in group A, but no significant differences were found at any other time point. Patient conditions were improved from initial time after injection and each follow up time in both group 1 and group 2 as per WOMAC score. And there was insignificant difference in group 1 and 2 scores.
Conclusion: In conclusion both intra-articular injections regimen showed nearly the same efficacy with clinically insignificant difference, steroids have chondrotoxicity and increase the risk of local infection. The author of the article believes that ketorolac intra-articular injection can have steroid’s effect but without the side effects. This is an interesting thought, but further studies are needed with large sample size and long term follow up. The conclusion I got from the study was like the authors, but I think that ketorolac can be used side by side with Corticoid steroids for osteoarthritic pain associated with foot and ankle. I think in clinic I would want to begin to use ketorolac injection prior to using corticosteroid just to see if injection can alleviate osteoarthritis for longer period prior to needing surgery if it doesn’t share the corticosteroid chondrotoxicity.