University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Primary Care


Dr. Elyse Watkins



Purpose: Knee pain is a common complaint in primary care. Many of these patients have osteoarthritis that can be treated in primary care. The purpose of this article is to review two treatment options for osteoarthritis (OA) of the knee and discuss the evidence for or against using either in primary care. The second part of this article is to instruct and encourage primary care providers to learn how to perform and to offer intraarticular injections as a treatment option in their practice.

Objectives: A journal article comparison of 2 intraarticular injection treatments for osteoarthritis of the knee. Then to give a brief instruction to simplify an intraarticular injection technique that can be done in primary care.

Method: A PubMed literature search was conducted with search terms Osteoarthritis, Corticosteroids, Hyaluronic Acid, Intraarticular Injection, Arthralgia, Aged, Adrenal Cortex hormones, Knee Pain, Treatment Guidelines, Anti-Inflammatory Agents. Fourteen articles were retrieved and serve as the basis for this clinical review.

Results: The review reveals that hyaluronic acid (HA) and intraarticular corticosteroid injection (IACI) both give patients temporary relief of knee osteoarthritis. But when doing a cost comparison, HA is too expensive to use in primary care.2


Knee pain is a common musculoskeletal complaint in primary care. Many of these patients’ knee pain is the result of mechanical destruction of the bone and cartilage. The destruction due to OA results in disability due to pain and loss of range of motion.1 Treatment options include surgical and nonsurgical options. Many patients with mild to moderate OA of the knee are not yet surgical candidates.4 The research reported that HA is superior to IACI by an average of one month. Both these two treatment options are safe and effective in improving symptoms and can be repeated. The studies reported a few differences between these interventions were duration in relief of symptoms and the cost to treat. Patient receiving HA reported pain relief lasting an average of 3 months and those with IACI reported only 2 months of relief. But a big difference was in total costs and availability. HA was the most expensive non-surgical alternative and is most commonly used by orthopedic specialists (see table 1).3,4 Therefore, patients can be offered a choice of IACI in primary care or referral for HA injection or surgical intervention in orthopedics.


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