Publication:

Comparative analysis of landmark-guided intra-articular knee injections in outpatient clinics versus ultrasound-guided injections: a quality improvement study

Background Osteoarthritis (OA) of the knee is a prevalent cause of chronic pain and reduced mobility. Intra-articular steroid injections are a key management option when oral analgesics fail to improve symptoms and surgery is not imminent. These injections can be performed using ultrasound guidance or anatomical landmark techniques (“blind”) depending on clinician expertise and hospital setting. However, referring patients for ultrasound (US) -guided procedures may increase waiting times and costs imposing a significant burden on hospital resources.

Methods A closed-loop audit at a London district general hospital evaluated the clinical and economic impact of US-guided versus landmark-guided intra-articular knee injections for osteoarthritis in an outpatient orthopaedic setting. The first (retrospective) cycle covered January–December 2023, and the second (prospective) cycle May–December 2024. Data from electronic health records, Picture Archiving and Communication Systems (PACS), and National Health Service (NHS) cost databases were analysed for waiting times (weeks) and procedural costs (£).

Results In 2023, 391 US-guided injections had an average waiting time of 16.2 weeks and cost ~£700 each, while 182 landmark-guided clinic injections averaged 15 weeks and cost ~£600. In 2024, 346 US-guided and 234 landmark-guided injections were performed, reducing US waiting times to nine weeks. A revised costing model achieved annual savings of ~£96,000. Increased clinic-based procedures reduced US demand, with no reported adverse events.

Conclusion Clinic-based, landmark-guided knee injections provide a safe, cost-effective and efficient alternative to US-guided procedures, significantly reducing waiting times, and preserving radiology resources while improving care delivery without compromising patient outcomes.