Intra-Articular Injections for Knee OA Do Not Increase Risk for Total Knee Replacement, Radiographic Progression

A Botox injection in the knee
A Botox injection in the knee
Researchers assessed the effect of intra-articular injections on risk for knee osteoarthritis over a 5-year period.

Patients with knee osteoarthritis (OA) who received treatment with intra-articular corticosteroid (IAC) injections did not have a significantly increased 5-year risk for incident total knee replacement (TKR) or radiographic progression, according to study results published in Arthritis & Rheumatology.

The researchers used marginal structural modeling with inverse probability of treatment weighting to establish the causal link between IAC injections and 5-year risk for disease progression in patients with symptomatic knee OA enrolled in the French multicentric, population-based Knee and Hip Osteoarthritis Long-term Assessment (KHOALA) cohort.

Progression of OA was defined as an incident TKR and/or radiographic worsening, according to the Kellgren-Lawrence (KL) grade or joint space narrowing. Researchers also evaluated the same outcomes among those who received intra-articular hyaluronan (IAHA) injections.

The primary study outcome was TKR.

Over the 5-year follow-up period, 564 patients were included in the study, 10.5% of whom underwent TKR surgery.

After adjustments for potential confounders, treatment with IAC injections (ie, IAC-treated knees) vs no treatment with IAC injections (ie, untreated knees) was not associated with increased risk for incident TKR (hazard ratio [HR], 0.92; 95% CI, 0.20-4.14; P =.91) or KL grade worsening (HR, 1.36; 95% CI, 0.85-2.17; P =.20).

Treatment with IAHA injections (ie, IAHA-treated knees) vs untreated knees was not associated with an increased risk for TKR (HR, 0.81; 95% CI, 0.14-4.63; P =.81) or KL grade worsening (HR, 1.36; 95% CI, 0.85-2.17; P =.20). 

Study limitations included the use of KL grade worsening to define knee OA progression that has been associated with several drawbacks, and the small sample size included in the analysis.

Overall, the researchers concluded, “These findings should be interpreted cautiously and replicated in other cohorts.”


Latourte A, Rat AC, Omorou A, et al. Do corticosteroids injections increase the risk of knee osteoarthritis progression over 5 years? Arthritis Rheumatol. Published online March 14, 2022. doi:10.1002/art.42118