Cortisone Injections For Hip And Knee Pain Are More Dangerous Than Was Thought

Dangerous Side Effects

A study published in the journal Radiology suggests that the cortisone injections commonly performed to treat osteoarthritis may be more dangerous than previously thought. The study found that cortisone injections can have adverse long-term effects for patients. (1)

What Are Cortisone Injections?

According to the Mayo Clinic, doctors use cortisone shots to relieve pain and inflammation associated with osteoarthritis. They may be injected into hips, knees, ankles, or other affected joints. (2)

These injections contain a corticosteroid medication and a local anesthetic. You can often get them at your doctor’s office. However, you are usually limited to three or four shots per year due to possible side effects. (2)

Osteoarthritis happens when the cartilage that cushions the bones wears down. It is the most common joint disorder in the United States. Besides osteoarthritis, doctors use cortisone shots to treat the following conditions (2, 3):

Back pain
Bursitis

Gout
Psoriatic arthritis
Reactive arthritis

Rheumatoid arthritis
Tendinitis

After getting a cortisone shot, you might find that your pain and inflammation increase for a few days. After that, they should subside, and the decrease in pain should last for several months. (2)

Study’s Findings

The study was conducted by a team from Boston University. The researchers looked at 459 patients who received a cortisone injection in the knee or hip in a US hospital in 2018. Of these patients, 218 did not undergo follow-up radiography or MRI. The study observed the medical imaging tests of those who did. (1, 3)

Researchers observed through medical imaging that 36 of those patients experienced adverse events in their joints. Those patients represent 8% of the group that received cortisone injections. (1, 3)

These adverse joint events include accelerated osteoarthritis progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction with bone loss. These negative effects may extend beyond the 8% of patients with complications observed by the study at this point. (1, 3)

The Boston University study references another 2019 study from a team at Massachusetts General Hospital. It looked at cortisone injections in the hip. They found that patients who received cortisone shots in the hip were more likely to show osteoarthritis progression three to 12 months after the injection. (1, 4)

The study from the team at Boston University was an observational study. To further support these findings, the researchers will need to conduct a double-blind study. (3)

Informed Patients

Study authors made some recommendations for clinical practice based on their findings. They urged doctors to inform patients of all the possible side effects when they’re choosing between treatment options. (1, 3)

Some patients are referred for cortisone injections for joint pain but don’t have osteoarthritis or have only a mild form of it. The authors of the study recommend that using cortisone injections as a treatment for these patients be closely scrutinized. Receiving cortisone shots could lead them to develop progressive joint space loss or progressive osteoarthritis. Patients should also be made aware of other treatment options. (1)

Finally, the researchers suggest that doctors order imaging of the joints before starting cortisone shots and as a follow-up. This will allow doctors to track joint and bone damage, as well as intervene before the condition progresses. (1)

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