Should doctors tell patients more about Knee Cortisone Injections?

There is conflicting evidence on the potential benefits of intra-articular corticosteroid (IACS) injections for the treatment of knee OA.

There appears to be a lack of prospective and large retrospective studies on the potential benefits and adverse effects related to IACS knee injections.

This recent paper published in the journal Radiology¹describes the following four main adverse joint findings observed in patients after IACS knee injections:

Accelerated OA progression
Subchondral insufficiency fracture
Complications of osteonecrosis
Bone loss

“Physicians do not commonly tell patients about the possibility of joint collapse or subchondral insufficiency fractures that may lead to earlier total hip or knee replacement. This information should be part of the consent when you inject patients with intra-articular corticosteroids.” Dr. A Guermazi (2019) ¹

However, for those with knee OA where exercise and manual therapies prove to be ineffective, they may consider platelet-rich plasma (PRP) injections instead.

The latest meta-analysis concludes that intra-articular PRP injections are effective in terms of pain relief and functional improvements in the treatment of knee OA with minimal adverse effects ²…It just costs $$$!

KompelAJ Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Radiology. 2019 Oct 15:190341.
Chen P et al Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses.J OrthopSurg Res. 2019 Nov 27;14(1):385.

KompelAJ Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Radiology. 2019 Oct 15:190341.

Chen P et al Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses.J OrthopSurg Res. 2019 Nov 27;14(1):385.