Corticosteroid and hyalurons

The research evidence from intra-articular corticosteroid injections is that it provides short term pain relief (from 1 to 4 weeks) with a small increase in physical function. This short pain relief may be useful for settling a flare up or as a means of introducing other interventions such as muscle strengthening exercises. NICE (2008) has recommended its use as an adjunct to core treatment. Hyalurons (previously known as hyaluronic acid) is produced by the lining layer cells of the joint. Its main function is to confer viscoelasticity, lubrication and help maintain tissue hydration. The mechanism by which commercial preparations of Hyalurons works is uncertain and the effect size for reduction in pain up to 3 months is small. NICE 2014 state; Do not offer intra-articular hyaluronan injections for the management of osteoarthritis.

Joint Lavage

Joint lavage means to wash out any loose tissue or debris from inside the joint space. Tidal irrigation joint lavage uses one entry point to alternatively inject fluid and then draw it out. Non-arthroscopic joint lavage uses two entry points, one to inject the fluid and a separate one for the withdrawal of the fluid but no visual inspection. Arthroscopic joint lavage is a washout plus a visual inspection. A Cochrane review (Reichenbach et al 2009) included 7 trials and found little benefit at 3 months both in terms of pain relief (0.3cm. on a 10cm. Visual analogue scale), and functional scores between joint lavage and control (0.2cm. on a WOMAC disability sub-scale from 0 to 10cm.). NICE 2014 recommends; Do not refer for arthroscopic lavage and debridement as part of treatment for osteoarthritis, unless the person has knee osteoarthritis with a clear history of mechanical locking (as opposed to morning joint stiffness, 'giving way' or X-ray evidence of loose bodies).

Hochman JR, Gagliese L, Davis AM, Hawker GA. 2011. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis and Cartilage19: 647-654.
National Institute for Health and Clinical Excellence.(2008). Osteoarthritis National Clinical Guideline for Care and Management in Adults. London: NICE
Reichenbach S, Rutjes AWS, Nuesch E et al 2009. Joint lavage for osteoarthritis of the knee. The Cochrane Collaboration, John Wiley & Sons Ltd.