A comparison of ultrasound guided corticosteroid injection vs ozone injection in grade 3 knee osteoarthritis

Osteoarthritis (OA) is a degenerative disease that can cause pain and limited function. One of the non-surgical treatments is intra-articular ozone injection. This study aimed to compare the effect of ultrasound-guided corticosteroid injection with ozone injection in patients with grade 3 osteoarthritis of the knee.

This randomized, double-blind, clinical trial was carried out in 32 participants with diagnosis of grade 3 knee osteoarthritis were divided into 2 groups randomly. In one group 40 mg triamcinolone (1 cc) injected into the knee joint (under ultrasound-guided in suprapatellar pouch). In another group under sterile conditions, 10cc oxygen-ozone (O2O3), (Ozone generator, Hyper Medozon Comfort, Herrmann Apparatebau GmbH, Kleinwallstadt, Germany) (15 μg/ml) under ultrasound-guided (in suprapatellar pouch), injected into the joint. This study was carried out in Physical Medicine and Rehabilitation, Clinic of Hazrat Rasul Akram and Firoozgar University Hospitals, Tehran, Iran, from September 2017 to August 2018. Outcome instruments were WOMAC, clinical parameters of the knee (knee flexion), ultrasound index (suprapatellar pouch) and pain, visual analog scale, VAS). Measurements were done before, 1 week and 1, 3 months after treatment. All injections were done under ultrasound guide. All patients were trained to perform knee strengthening exercises.

From 32 patients, 7 men and 25 women were enrolled in our study. The mean age of patients, in the steroid group was 58.50 and in the ozone group was 60.06 years. Recovery was significant after treatment in both groups (P<0.05). Our results showed that there was the improvement in VAS criteria in both groups before and after treatment but there was no significant difference between the two groups (P=0.261). There was no significant difference in the WOMAC score between the two groups (P=0.265). The recovery in one month after treatment, was in favor of the ozone group (P=0.008). There was no significant difference in ROM criteria and joint effusion between the two groups (ROM P=0.270, Effusion P=0.630), but in the ozone group, joint effusion was decreased (P=0.009).

Steroid and ozone injections has no superiority to each other in the improvement of pain, function, ROM, and effusion in patients with grade 3 knee osteoarthritis.