Francisco Ramirez Lafita, MD, FACP; Joan M. Castella, MD
What is the efficacy of joint lavage, alone or with intraarticular steroid injection, for symptomatic osteoarthritis of the knee?
Included studies compared the efficacy of joint lavage (done using 1 or 2 large needles or by arthroscopy) with a control group, or joint lavage plus intraarticular steroid injection with joint lavage alone in patients with knee osteoarthritis (based on American College of Rheumatology criteria or radiography). Outcomes were change in pain (global pain, pain on walking, Western Ontario and McMaster Universities OA Index [WOMAC] pain subscore, Lequesne index, or pain with activity other than walking) and physical function (WOMAC function subscore, Lequesne index, or Arthritis Impact Measurement Scales—Walking-bending subscale) at 3 months after joint lavage.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials were searched from 1966 to May 2009 for English-language, parallel-group, randomized controlled trials (RCTs); reference lists of identified studies were also searched. 6 RCTs (n = 855, mean age 62 y, 52% women) met the selection criteria. 5 trials had Jadad scores ≥ 3 out of 5.
Joint lavage did not differ from placebo for pain intensity or physical function (Table). Joint lavage plus intraarticular steroid injections did not differ from joint lavage alone for pain intensity or physical function (Table).
In patients with symptomatic knee osteoarthritis, joint lavage does not reduce pain intensity or improve physical function compared with placebo. Joint lavage plus intraarticular steroid injections does not differ from joint lavage alone.
Joint lavage, with or without intraarticular (IA) steroid injections, for symptomatic knee osteoarthritis*
*CI defined in Glossary.
†Positive difference favors treatment. All differences are not significant. Based on a random-effects model unless otherwise indicated.
‡Based on a fixed-effect model.
Lafita FR, Castella JM. Review: Joint lavage does not reduce pain or improve function in knee osteoarthritis. Ann Intern Med. 2010;153:JC2–2. doi: 10.7326/0003-4819-153-4-201008170-02002
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Published: Ann Intern Med. 2010;153(4):JC2-2.
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