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Specialists who perform knee injections for patients with osteoarthritis of the knee are 95% certain they are putting their needles in the right place, and in the vast majority of cases they are wrong, according to research presented here at the 2010 Annual Scientific Meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP).

However, using new, noninvasive ultrasound equipment, physicians can dramatically improve their ability to accurately inject patients compared with standard palpation techniques.

"The study demonstrates that when physicians use ultrasound and hydro-dissection performed with precise new mechanical syringes to inject the joint, the patient experiences less pain, improved safety, a better response to medications, and less need for other medical therapy," said Wilmer Sibbitt, Jr., MD, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.

Dr. Sibbitt and colleagues demonstrated that when compared with the palpation-guided method, the ultrasound-guided method improved results: a 107% increase in the number of people who responded to the treatment (P <.001) and a 51.6% reduction in the number of people who did not (P <.001).

He also observed a 47.7% reduction in procedural pain (P <.001); a 41.7% reduction in pain 2 weeks after the injection (P <.03), and a 35.5% increase in duration of relief of pain (P <.001).

"Rheumatologists are increasingly using ultrasound, and patients should be aware that joint injections may be more effective and less painful if their physician offers this option to them," Dr. Sibbitt said during a press briefing on November 9, prior to the study presentation on November 11.

The researchers sought to determine if ultrasound guidance would affect the outcomes of intra-articular injections in adults with knee osteoarthritis. They evaluated outcomes in 94 knees, which were randomly selected for injection administered either by the conventional palpation-guided method or by the newer ultrasound-guided method that allows doctors to watch, in real time, the needle entering and exiting the joint.

Both the palpation and ultrasound -guided methods involved 1 needle, with a syringe attached, entering the joint to remove fluid from it. After that was accomplished, the first syringe was removed with the needle remaining inserted and a second syringe was used to inject 80 mg of a corticosteroid through the same needle. This technique ensured the medication was injected into the correct place. When using the ultrasound-guided method, researchers were able to perform the procedure while confirming needle placement as well as administration of the lidocaine and the corticosteroid by viewing the procedure as it occurred.

Each participant's initial pain, pain during the procedure, and knee pain at the end of 2 weeks and 6 months were studied. Researchers looked at who responded to the treatment, the length of time the participants experienced pain relief after the injection, how often participants needed to be re-injected, the total cost of the procedure, and the cost per participant who responded to the treatment.

Source: DG News

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