Technique Update: Steroid Injections for Hip and Knee Arthritis May Damage Joints and Bone
By Dr. David Graber, Council on Technique and Clinical Excellence Chair
A recent study published in the journal Radiology found that intra-articular corticosteroid injections (IACI) for osteoarthritis (OA) of the hip or knee had several adverse long-term consequences. The most common were: accelerated OA progression (6%), subchondral insufficiency fracture (0.9%), complications of osteonecrosis and rapid joint destruction including bone loss (0.7% each). The rapid loss of the joint space, more than the expected rate, hastens the need for joint replacement in these patients.
The researchers conducted a search on patients they had injected in the hips and knees and found an overall complication rate of 8%, with 10% in the hips and 4% in the knees.
IACI has been shown to give short-term pain relief, but the duration of that relief is unclear. A 2015 Cochrane review of 27 meta-analysis studies described varying degrees of relief are obtained for one to six weeks, and no beneficial effects are found six months after the injections.
A study in 2016 found that more than one-third of Medicare patients newly diagnosed with knee arthritis were treated for it with IACI injections.
One of the biggest concerns is the use of IACI in younger patients and those with joint pain who show no or little signs of OA on X-ray. These patients should be “closely scrutinized,” with follow-up X-rays to monitor their condition for joint-space loss or subchondral fractures. Further, some patients who develop rapid, progressive joint-space loss or destructive OA tend to have no OA or only mild OA at initial presentation.
Sources:
https://pubs.rsna.org/doi/10.1148/radiol.2019190341
https://pubs.rsna.org/doi/full/10.1148/radiol.2019192034
https://www.rsna.org/en/news/2019/October/Steroid-Injections-Hip-Knee
https://www.ncbi.nlm.nih.gov/pubmed/26421601
https://josr-online.biomedcentral.com/articles/10.1186/1749-799X-3-3
https://www.healthline.com/health-news/steroid-injections-in-the-knee-and-hip-can-cause-more-damage
Originally published in the ANJC Back Channel, Oct. 23, 2019
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