Common Knee Pain Treatment: More Harm Than Good?

Rapid progressive osteoarthritis joint space loss (type 1) and subchondral insufficiency fracture.

New evidence that steroid injections of hip and knee may damage joints

Oct 15, 2019

| Radiological Society of North America – Corticosteroid injections used to treat osteoarthritis pain in the hip and knee may be more dangerous than previously thought, according to a special report published in the journal Radiology.

Researchers suggested that injection-associated risks like rapid progressive osteoarthritis, which eventually may lead to joint collapse, should be integrated into consent forms so that patients are aware of the potential risks associated with these treatments.

Osteoarthritis of the hip and knee are common and debilitating joint disorders.

Physicians often inject anti-inflammatory corticosteroids into the joint to treat the pain and swelling associated with osteoarthritis.

The procedure is widely viewed as safe, and patient consent forms mainly mention the risks of hemorrhage and infection among more rare side effects associated with most needle-based procedures.

However, a recent study led by Ali Guermazi, M.D., Ph.D., professor of radiology and medicine at Boston University School of Medicine, found that corticosteroid injections may be associated with complications that potentially accelerate the destruction of the joint and may hasten the need for total hip and knee replacements:

“We’ve been telling patients that even if these injections don’t relieve your pain, they’re not going to hurt you. But now we suspect that this is not necessarily the case.”

In a review of existing literature on complications after treatment with corticosteroid injections, Dr. Guermazi and colleagues identified four main adverse findings:

  • accelerated osteoarthritis progression with loss of the joint space,
  • subchondral insufficiency fractures (stress fractures that occur beneath the cartilage),
  • complications from osteonecrosis (death of bone tissue),
  • and rapid joint destruction including bone loss.

The researchers recommend careful scrutiny of patients with mild or no osteoarthritis on X-rays who are referred for injections to treat joint pain, especially when the pain is disproportionate to the imaging findings. Read more.