Osteoarthritis (OA) of the knee is a very common chronic joint disorder associated pain and
disability. As no cure exists, management aims to reduce pain, improve function, and enhance
quality of life. The recommended hierarchy of management should consist of exercise in first
line, then the add-on of drugs if necessary, and ultimately, if necessary, surgery.
The effect size of exercise therapy is of the same magnitude as most pharmacological
treatments but is often without adverse effects. Local pharmacological treatment of the
afflicted knee joint is recommended by means of intra-articular injections of
corticosteroids, which is considered as a standard medical treatment of knee OA and are
included in established guidelines for management of knee OA. While the two treatment
approaches have been investigated separately in numerous clinical trials, the efficacy of a
combined pharmacological and non-pharmacological approach is not known, despite the high rank
of such combined treatment approach on the recommended hierarchy of management.
The purpose of this study is to assess the effects of exercise therapy in combination with
intra-articular corticosteroid injections on patient reported pain and function in patients
with knee OA.
The hypothesis is that the combined treatment approach (exercise therapy preceded by
intra-articular injection of corticosteroid) enhances the clinical outcome compared to
exercise therapy preceded by a placebo injection.