title: Will a single periarticular lidocaine-corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis?
abstract: OBJECTIVE
  A local injection of corticosteroid-lidocaine into the periarticular soft tissue structures is used commonly for rapid pain relief. It is hypothesized that knee pain associated with knee osteoarthritis would be relieved quickly and effectively in patients receiving intraarticular hyaluronic acid combined with a periarticular lidocaine-corticosteroid injection. To test this hypothesis, the clinical effect of the combined treatment with hyaluronic acid injection alone in patients with symptomatic knee osteoarthritis as compared in this prospective single-blinded randomized trial.
  
  
  METHODS
  This study included 70 patients. Group 1 (n = 35) received intraarticular hyaluronic acid injections only, whereas group 2 (n = 35) received intraarticular hyaluronic acid injections combined with a single local injection of corticosteroid-lidocaine. Injections were administered to the most painful areas of the anterior or posterior medial condyle of the femur or tibia. The outcome was measured by independent assessors (blinded to treatment) using a linear VAS pain scale and WOMAC and HSS knee scores. Assessments were performed at baseline and at 1, 3, 6, 12, 26, and 52 weeks.
  
  
  RESULTS
  During the first 3 weeks, group 2 patients showed significantly better all scores than did group 1 patients (p < 0.01). However, no significant differences were detected at 6, 12, 26 or 52 weeks (n.s.).
  
  
  CONCLUSIONS
  The combined treatment may lead to earlier pain relief compared with intraarticular hyaluronic acid alone in patients with knee osteoarthritis and can be considered a useful adjunctive treatment modality. This combined method may provide early return to patient's daily activity.
  
  
  METHODS
  Therapeutic study, Level I.
authors.affiliation: Department of Orthopedic Surgery, Harran University Faculty of Medicine, 63100, Yenisehir, Sanliurfa, Turkey. erturkc@yahoo.com.
authors.forename: Cemil
authors.initials: C
authors.lastname: Ertürk
authors.affiliation: Department of Orthopedic Surgery, Harran University Faculty of Medicine, 63100, Yenisehir, Sanliurfa, Turkey.
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Altay
authors.affiliation: Department of Anesthesiology and Reanimation, Harran University Faculty of Medicine, Sanliurfa, Turkey.
authors.forename: Nuray
authors.initials: N
authors.lastname: Altay
authors.affiliation: Department of Orthopaedic Surgery, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey.
authors.forename: Ali Murat
authors.initials: AM
authors.lastname: Kalender
authors.affiliation: Department of Orthopedic Surgery, Harran University Faculty of Medicine, 63100, Yenisehir, Sanliurfa, Turkey.
authors.forename: İbrahim Avşin
authors.initials: İA
authors.lastname: Öztürk
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001623:Betamethasone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007267:Injections; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000187:drug effects; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D055675:Viscosupplements / Q000627:therapeutic use*
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D055675:Viscosupplements; C011175:betamethasone-17,21-dipropionate; D006820:Hyaluronic Acid; D001623:Betamethasone; D008012:Lidocaine
keywords: Combined treatment; Intraarticular hyaluronic acid injection; Knee osteoarthritis; Periarticular corticosteroid-lidocaine injection; Periarticular pain