A randomized controlled trial evaluating the cost-effectiveness of sonographic guidance for intra-articular injection of the osteoarthritic knee

J Clin Rheumatol. 2011 Dec;17(8):409-15. doi: 10.1097/RHU.0b013e31823a49a4.


Objective: The present randomized controlled study investigated whether sonographic needle guidance affected the outcomes of intra-articular injection for osteoarthritis of the knee.

Methods: 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.

Results: 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).

Conclusions: Sonographic needle guidance reduced procedural pain and improved the clinical outcomes and cost-effectiveness of intra-articular injections of the osteoarthritic knee.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Injections, Intra-Articular / adverse effects
  • Injections, Intra-Articular / economics*
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / drug therapy*
  • Pain / prevention & control
  • Pain Measurement
  • Treatment Outcome
  • Triamcinolone Acetonide / administration & dosage*
  • Ultrasonography, Interventional / economics*


  • Triamcinolone Acetonide