A Randomized Controlled Trial Evaluating the Cost-Effectiveness of Sonographic Guidance for Intra-Articular Injection of the Osteoarthritic Knee

JCR: Journal of Clinical Rheumatology | December 02, 2011

Sibbitt WL et al. – Sonographic needle guidance reduced procedural pain and improved the clinical outcomes and cost–effectiveness of intra–articular injections of the osteoarthritic knee.


  • Ninety–four noneffusive knees with osteoarthritis were randomized to injection by conventional palpation–guided anatomic landmark injection or sonographic image–guided injection enhanced with a 1–handed mechanical (the reciprocating procedure device) syringe.
  • After intra–articular placement and synovial space dilation were confirmed by sonography, a syringe exchange was performed, and 80 mg of triamcinolone acetonide was injected with the second syringe through the indwelling intra–articular needle.
  • Baseline pain, procedural pain, pain at outcome (2 weeks and 6 months), responders, therapeutic duration, reinjection rates, total cost, and cost per responder were determined.


  • Relative to conventional palpation–guided anatomic landmark methods, sonographic guidance for injection of the knee resulted in 48% reduction in procedural pain (P<0.001), a 42% reduction in pain scores at outcome (P<0.03), 107% increase in the responder rate (P<0.001), 52% reduction in the nonresponder rate (P<0.001), a 36% increase in therapeutic duration (P=0.01), a 13% reduction ($17) in cost per patient per year, and a 58% ($224) reduction in cost per responder per year for a hospital outpatient (P<0.001).

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