If you’ve got osteoarthritis (OA) in your hip or knee, your doctor has probably recommended a range of treatment options, including exercise and an over-the-counter or prescription pain reliever. But those standard therapies don’t always do the job, and a steroid injection has long been among the next steps to tamp down the pain—even though there have been questions about the safety of this treatment.

Now: To better understand the potential side effects of these shots, researchers at Boston University School of Medicine tracked patients who got a steroid injection in 2018 to treat pain and swelling of the hip or knee due to OA. Based on their findings, the researchers concluded that this treatment is riskier than patients have been told—and may even hasten the need for total hip or knee replacement.

Study details: Among the nearly 500 patients tracked in the study, there was an 8% complication rate, which was much higher than expected. Even though patients are asked to sign a consent form, which describes the possibility of rare bleeding or infection from the injection, other serious complications not forewarned about were identified in this study.

Patients who received steroid shots were also found to be at increased risk for…

  • Accelerated OA progression.
  • Complications from death of bone in the joint, a condition called osteonecrosis.
  • Rapid joint destruction, including bone loss.
  • Stress fractures that occur beneath the cartilage, known as subchondral insufficiency fracture.

Some patients were at greater risk for complications than others. For example, a steroid injection could mask the pain in those who already had a subchondral insufficiency fracture, allowing them to put weight on the joint, which worsens the fracture. Interestingly, those whose X-ray findings did not show OA or only mild OA were at at higher risk for rapid worsening of their pain.  

Corticosteroid injections do help some people get relief from their pain and swelling, but the effects typically fade within a matter of months. Despite being widely used, the treatment is usually limited to three to four injections per year since doctors worry that more frequent injections can worsen OA.

Takeaway: The dangers of steroid injections for hip or knee OA have been underestimated. If your doctor suggests a steroid joint injection, you may be trading temporary pain relief for an even worse problem in the future. Based on their findings, the researchers also suggest that consent forms need to be updated to include the complications found in this study. Before you give your consent for a steroid injection, take some time to discuss the risks and benefits with your doctor. Getting an X-ray before an injection could also help identify patients who are more likely to experience complications.

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