A new approach in the treatment of ultrasound-guided synovial hypertrophy

Abstract

Background/aimKnee osteoarthritis (OA) causes pain, limited movement, and negatively impacts daily life in older adults. Hypertrophy and changes in the synovial tissue significantly contribute to the pain. While intra-articular injections are common in OA treatment, specific therapies for hypertrophic tissue are rarely mentioned. This study aims to evaluate the long-term outcomes of local anesthetic and steroid injections in the knee's intra-articular space and hypertrophic synovial tissue.Materials and methodsOur retrospective study included patients with grade 3-4 kne OA diagnosed with ultrasound-guided suprapatellar effusion and synovial hypertrophy. Pain was assessed using the Numerical Rating Pain Scale (NRS), and functional capacity was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Effusion was first drained from the suprapatellar region using needle under ultrasound guidance, followed by lavage with 40 ml of 0.9% NaCl solution. A mixture of 10 ml (2 ml Triamcinolone Hexacetonide, 7 ml prilocaine, and 1 ml 0.9% NaCl) was injected intra-articularly, and 6 ml was injected into the hypertrophic synovial tissue. Patients were followed up before the injection and at 1, 3, 6, 9, and 12 months post-injection.ResultsAnalysis of the WOMAC scores and NRS values at 1, 3, 6, 9, and 12 months post-injection showed a statistically significant reduction (p < 0.05). No statistical difference was found between the duration of complaints and WOMAC scores or NRS values (p > 0.05). Ultrasound evaluation indicated regression of the synovial hypertrophy tissue.ConclusionThis injection method, practiced in the treatment of synovial hypertrophy as one of the causes of pain in knee OA, has reduced pain and significantly increased functional capacity.