Intraarticular Injections of the Hip and Knee with Triamcinolone versus Ketorolac: A Randomized Controlled Trial

Abstract Purpose Clinicians commonly utilize intraarticular injections to treat symptomatic primary arthritis. Steroid injections are common yet have immune-modulating effects and can alter gene expression which may delay definitive arthroplasty and further damage cartilage. Non-steroidal anti-inflammatory (NSAID) injections may offer a safer profile due to their differing mechanism of action; however, there is a relative dearth of information regarding their efficacy. This non-inferiority study compares the effectiveness of triamcinolone versus ketorolac in treating symptoms of moderate to advanced primary osteoarthritis of the hip and knee. Methods 110 patients (52 hips and 58 knees) with moderate to severe radiographic primary osteoarthritis of the hip or knee were randomized in a double-blinded study to receive an ultrasound guided intraarticular injection of ketorolac or triamcinolone. Patient reported outcome measures (PROMs) were collected pre-injection and at 1-week, 1-month, and 3-months. Summary of Results For hips and knees, intraarticular injections with either ketorolac or triamcinolone led to statistically significant improvements in PROMs. The treatment effect size was largest at 1 week and decreased over time. Primary ANOVA comparisons revealed no significant differences between ketorolac and triamcinolone. For knee injections, post-hoc secondary analysis suggests slight added durability in the triamcinolone group. Adverse effects were minimal with both interventions. Conclusion Intraarticular ketorolac injections provide comparable improvement to triamcinolone for primary hip and knee osteoarthritis. Ketorolac is an additional low-cost option for conservative management of primary osteoarthritis; and due to its differing mechanism of action, it may not propagate additional cartilage damage or preclude from early surgical intervention if unsuccessful. Trial Registration Number NCT04441112