title: A randomized controlled trial evaluating the cost-effectiveness of sonographic guidance for intra-articular injection of the osteoarthritic knee.
abstract: OBJECTIVE
  The present randomized controlled study investigated whether sonographic needle guidance affected the outcomes of intra-articular injection for osteoarthritis of the knee.
  
  
  METHODS
  Ninety-four noneffusive knees with osteoarthritis were randomized to injection by conventional palpation-guided anatomic landmark injection or sonographic image-guided injection enhanced with a 1-handed mechanical (the reciprocating procedure device) syringe. After intra-articular placement and synovial space dilation were confirmed by sonography, a syringe exchange was performed, and 80 mg of triamcinolone acetonide was injected with the second syringe through the indwelling intra-articular needle. Baseline pain, procedural pain, pain at outcome (2 weeks and 6 months), responders, therapeutic duration, reinjection rates, total cost, and cost per responder were determined.
  
  
  RESULTS
  Relative to conventional palpation-guided anatomic landmark methods, sonographic guidance for injection of the knee resulted in 48% reduction in procedural pain (P < 0.001), a 42% reduction in pain scores at outcome (P < 0.03), 107% increase in the responder rate (P < 0.001), 52% reduction in the nonresponder rate (P < 0.001), a 36% increase in therapeutic duration (P = 0.01), a 13% reduction ($17) in cost per patient per year, and a 58% ($224) reduction in cost per responder per year for a hospital outpatient (P < 0.001).
  
  
  CONCLUSIONS
  Sonographic needle guidance reduced procedural pain and improved the clinical outcomes and cost-effectiveness of intra-articular injections of the osteoarthritic knee.
authors.affiliation: Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA. wsibbitt@salud.unm.edu
authors.forename: Wilmer L
authors.initials: WL
authors.lastname: Sibbitt
authors.forename: Philip A
authors.initials: PA
authors.lastname: Band
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Kettwich
authors.forename: Natalia R
authors.initials: NR
authors.lastname: Chavez-Chiang
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Delea
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Bankhurst
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects / Q000191:economics*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional / Q000191:economics*
chemical_list: D014222:Triamcinolone Acetonide