Comparison of Single versus Multiple Intra-articular Steroid Injections in Knee Osteoarthritis (Grade II–III): A Retrospective Study

Background: Intra-articular corticosteroid injections are commonly used for symptomatic relief in knee osteoarthritis (OA). However, the relative efficacy and safety of single versus multiple injections remain debated, particularly in early to moderate disease. Objective: To compare clinical outcomes of single versus multiple intra-articular steroid injections in patients with Kellgren–Lawrence grade II and III knee osteoarthritis. Methods: A retrospective observational study was conducted at Bhima Bhoi Medical College & Hospital, Balangir, from October 2024 to September 2025. A total of 302 patients with grade II–III knee OA who received either a single injection or multiple injections of intra-articular corticosteroid were analyzed. Pain and function were assessed using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Statistical analysis included paired and unpaired t-tests and chi-square tests, with p < 0.05 considered significant. Results: Both groups showed significant improvement in VAS and WOMAC scores at short-term follow-up. Multiple injections demonstrated superior pain relief at 6 months but were associated with a higher recurrence of symptoms by 9–12 months. Conclusion: Single intra-articular steroid injection provides effective short-term relief in grade II–III knee OA, while multiple injections may offer prolonged benefit at the cost of potential diminishing returns. Judicious use is recommended.