Efficacy of IPACK Block Combined With Intra-articular Steroid Injection in Advanced Knee Osteoarthritis: A Retrospective Cohort Study

NCT07269444 | Completed

• 1 other identifier: knee osteoarthritis
• Study Type: observational
• Target: 98
• Locations: 1 country
• Sites: 1

Brief Summary

Osteoarthritis (OA) is a degenerative joint disease characterized by the progressive degeneration of articular cartilage resulting from the interaction of genetic, metabolic, and biochemical factors and is often accompanied by secondary inflammation. This condition represents a pathological process involving the dynamic interaction of cartilage degradation and repair mechanisms affecting the cartilage, subchondral bone, and synovium. Osteoarthritis is the most common joint disease worldwide and represents one of the leading causes of physical disability. Pain is the most prominent symptom of osteoarthritis. It typically increases with activity and decreases with rest. As the disease progresses, pain may occur with minimal activity and can eventually be present at rest and during the night. The knee joint is a synovial joint formed between the femoral condyles and the tibia. Sensory innervation of the knee joint is provided by branches of the femoral, obturator, and sciatic nerves. Pain associated with knee osteoarthritis is a common clinical problem that can lead to functional limitation and reduced quality of life. In many patients with chronic knee pain due to osteoarthritis, pharmacological treatments and/or physical therapy may not provide sufficient analgesia. Knee arthroplasty is the most frequently used treatment option for advanced knee osteoarthritis; however, it may not be suitable for some patients because of comorbidities. Currently, one of the most commonly used interventional treatment methods for pain control in knee osteoarthritis is intra-articular steroid injection. This treatment reduces synovial inflammation and may slow disease progression. However, repeated steroid injections may provide only short-term pain relief and may also contribute to cartilage degeneration. In recent years, alternative interventional approaches for the management of osteoarthritis-related knee pain have gained increasing attention. The nerves responsible for knee joint pain originate from both the anterior and posterior aspects of the joint. The IPACK (infiltration between the popliteal artery and the capsule of the knee) block is a simple and practical technique performed under ultrasound guidance. Although it is primarily intended to block the posterior articular innervation of the knee, cadaveric studies suggest that the anterior genicular nerves may also be affected. Therefore, the IPACK block may serve as an alternative treatment option for providing additional analgesia in patients with advanced knee osteoarthritis. The aim of this study was to investigate the effects of an IPACK block combined with intra-articular steroid injection on pain scores in patients with chronic knee osteoarthritis.

Conditions

Knee Osteoarthritis (Knee OA); IPACK Block Multimodal Analgesia; Intraarticular Injection; Ultrasound Guided Injection

Outcome Measures

Primary Outcomes (1)

• 1. Numeric Rating Scale (NRS-11): The NRS-11 is an 11-point numerical scale (9) that allows patients to rate their pain from 0 (no pain at all) to 10 (the most severe pain they have ever experienced). It was assessed three times: pre-treatment, 1 month a

  6 month

Secondary Outcomes (1)

• Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC):

  6 month

Study Arms (1)

Comparison of the Effectiveness of Ultrasonography-Guided Intra-Articular Steroid Injection and IPAC

Eligibility Criteria

• Age: 40 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Patients presenting to a tertiary hospital in Istanbul, Turkey, with knee pain and diagnosed with stage 3-4 knee osteoarthritis based on clinical and radiological findings between January 2024 and September 2025 were included in the study. The procedure was performed on a single knee, and the contralateral knee was not treated.

You may qualify if:

• Patients over 40 years of age
• Diagnosed with primary knee osteoarthritis according to ACR (American College of Rheumatology) criteria based on clinical, radiological, and laboratory evaluations
• Activity VAS score of 5 or higher despite previous medical and physical therapy
• Patients with stage 3-4 knee osteoarthritis according to the Kellgren-Lawrence classification
• Patients without motor or sensory loss on neurological examination
• Patients who signed an informed consent form
• Patients who have not undergone any interventional procedures on the knee within the last 6 months

You may not qualify if:

• Patients with bleeding or coagulation disorders
• Patients with sepsis or local infection at the intervention site
• Patients with allergies to any of the medications to be used
• Patients without study consent
• Patients with secondary osteoarthritis
• Patients who have undergone knee interventions in the last 6 months
• Patients who have undergone knee surgery
• Psychosis

Sponsors & Collaborators

• Kanuni Sultan Suleyman Training and Research Hospital: lead
• Prof. Dr. Cemil Tascıoglu Education and Research Hospital Organization: collaborator

Study Sites (1)

Kanuni Sultan Süleyman Training and Research Hospital

Küçükçekmece, Istanbul, (507) 277-4773, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Osteoarthritis, Knee

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Director, Head of pain medicine

Study Record Dates

• First Submitted: November 25, 2025
• First Posted: December 8, 2025
• Study Start: December 5, 2025
• Primary Completion: December 10, 2025
• Study Completion: December 23, 2025
• Last Updated: March 11, 2026

Record last verified: 2026-03

Locations

TU (1)