Corticosteroid injection into the osteoarthritic knee: drug selection, dose, and injection frequency

Objective: Although some disagreement exists amongst practitioners as to the efficacy of corticosteroid injection into the osteoarthritic knee, this procedure remains the most common reason to perform knee joint injection. There is disagreement too over the most efficacious corticosteroid for the procedure; the dose required at injection; the frequency, and total quantity of corticosteroid that can be injected into the knee. This paper examines the controversies surrounding the efficacy of corticosteroid injection into the osteoarthritic knee, and attempts to provide guidance as to appropriate corticosteroid selection, dose, and treatment interval. Method: Searches were made of electronic databases, and appropriate papers were identified and hand-searched. Results and Conclusion: Although numerous investigations have been conducted in an attempt to identify the optimal corticosteroid agent, and its optimal dosing regimen for the intra-articular treatment of osteoarthritis, a consensus has not been established. The current recommendations for dosing interval appear to have arisen as a consequence of a misinterpretation of previously published works. This paper recommends that practitioners refine and individually tailor their selection of agent and dosing regimen to patient needs and clinical response.