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Changes in biomechanics, strength, physical function, and daily steps after extended-release corticosteroid injections in knee osteoarthritis: a responder analysis

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Abstract

Introduction/Objective

To determine changes in gait biomechanics, quadricep strength, physical function, and daily steps after an extended-release corticosteroid knee injection at 4 and 8 weeks post-injection in individuals with knee osteoarthritis as well as between responders and non-responders based on changes in self-reported knee function.

Method

The single-arm, clinical trial included three study visits (baseline, 4 weeks, and 8 weeks post-injection), where participants received an extended-release corticosteroid injection following the baseline visit. Time-normalized vertical ground reaction force (vGRF), knee flexion angle (KFA), knee abduction moment (KAM), and knee extension moment (KEM) waveforms throughout stance were collected during gait biomechanical assessments. Participants also completed quadricep strength, physical function (chair-stand, stair-climb, 20-m fast-paced walk) testing, and free-living daily step assessment for 7 days following each visit.

Results

All participants demonstrated increased KFA excursion (i.e., greater knee extension angle at heel strike and KFA at toe-off), increased KEM during early stance, improved physical function (all p < 0.001), and increased quadricep strength at 4 and 8 weeks. KAM increased throughout most of stance at 4 and 8 weeks post-injection (p < 0.001) but appears to be driven by gait changes in non-responders. Non-responders demonstrated lesser vGRF during late stance and lesser KEM and KFA throughout stance compared to responders at baseline.

Conclusions

Extended-release corticosteroid injections demonstrated short-term improvements in gait biomechanics, quadricep strength, and physical function for up to 4 weeks. However, non-responders demonstrated gait biomechanics associated with osteoarthritis progression prior to the corticosteroid injection, suggesting that non-responders demonstrate more deleterious gait biomechanics prior to corticosteroid injection.

Key Points

• Individuals with knee osteoarthritis who were treated with extended-release corticosteroid injections demonstrated improvements in gait biomechanics and physical function for 8 weeks.

• Individuals with knee osteoarthritis, who walked with aberrant walking biomechanics before treatment, failed to respond to extended-release corticosteroid treatment.

• Future research should determine the mechanisms contributing to the short-term changes in gait biomechanics and physical function such as reduced inflammation.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonablerequest.

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Funding

This study was funded by the Pacira Biosciences, Inc. (formerly known as Flexion Therapeutics).

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Authors and Affiliations

  1. Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA

    Caroline Lisee, Elizabeth Bjornsen & Brian Pietrosimone

  2. Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    David Berkoff, Karen Blake & Brian Pietrosimone

  3. Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Todd Schwartz

  4. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Todd Schwartz

  5. Department of Statistics, University of California Santa Cruz, Santa Cruz, CA, USA

    W. Zachary Horton

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  1. Caroline Lisee
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Correspondence to Caroline Lisee.

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Lisee, C., Bjornsen, E., Berkoff, D. et al. Changes in biomechanics, strength, physical function, and daily steps after extended-release corticosteroid injections in knee osteoarthritis: a responder analysis. Clin Rheumatol 42, 1863–1874 (2023). https://doi.org/10.1007/s10067-023-06568-x

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