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

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.

NCT Number	NCT07269444
Lead Sponsor	Kanuni Sultan Suleyman Training and Research Hospital Collaborators: Prof. Dr. Cemil Tascıoglu Education and Research Hospital Organization
Conditions	Knee Osteoarthritis (Knee OA), IPACK Block Multimodal Analgesia, Intraarticular Injection, Ultrasound Guided Injection
Enrollment	98 participants
Start Date	2025-12-05
Primary Completion	2025-12-10 (estimated)
Study Completion	2025-12-23 (estimated)
Updated on ClinicalTrials.gov	2026-03-11