For those suffering from hip or knee pain, it had long been thought that before going down the surgical route, steroid injections could provide some relief caused by the discomfort of joint osteoarthritis. New research has been published that challenges this belief, suggesting that cortisone injections could actually be doing more harm than good.
Steroid injections are an anti-inflammatory drug that can help numb the pain in deteriorating hip and knee joints. The NHS website explains that “steroid injections in joints are intended to relieve joint pain by reducing inflammation. In the UK, you may be offered this type of injection if you have moderate to severe pain from osteoarthritis.”
The new research has been published by the Boston University School of Medicine, whose findings suggest “that the treatment could speed up a joint’s disintegration and force patients to have total knee or hip replacements.” There is also a higher complication rate in joints following this type of injection, with one in ten hip replacement patients in the study in 2018 experiencing complications and four per cent of those with knee complaints.
The study, comprising data from over 450 US patients, indicates that complications such as “stress fractures, progressive osteoarthritis or even the collapse of joints” were experienced more so by those who had undergone treatment with steroid injections.
Report authors are pushing for greater access to information for patients who are recommended steroid injections. With greater knowledge comes greater opportunity to challenge and to decide whether or not the treatment is something they wish to progress with. Dr Ali Guermazi who lead the research explains “what we wanted to do with our paper is to tell physicians and patients to be careful, because these injections are likely not as safe as we thought.”
Mr Bridle concurs with these concerns and believes that hip and knee steroid injections can sometimes be beneficial to patients, but must be used sparingly. Typically, the kind of patient who would benefit the most from steroid injections is those whose symptoms are not bad enough to consider a full joint replacement. They can also help mask the pain for those who have important events in the near future that they are not able or willing to miss, such as golfing or a holiday. Not only that, much older patients who are not considered suitable for surgery can benefit from the pain relief offered by this type of treatment.
Steroid injections for hip pain
Steroid injections can also sometimes be used as a diagnostic tool. When administered into the joint they can help surgeons ascertain whether or not it is the joint that is the primary source of the pain and mobility issues. When used in this way it can help guide whether or not joint surgery is a suitable and effective next step for the patient.
It is important that if steroid injections are used as part of patient care or as part of a diagnostic assessment, they must be used in moderation. Mr Bridle’s approach is to give no more than two or three steroid injections before switching to an alternative approach or different kind of treatment.
This research is important as it has raised important questions about the possible side effects of cortisone injections, however, the small sample size indicates that there is a strong case for follow up research, with a larger base. The NHS recommends that realistically, “large-scale, long-term studies are needed to give us an accurate picture of the possible risk of joint damage after injections.” Until that data is available, surgeons are best to do as Mr Bridle does, and proceed with caution.
For more advice on the appropriate treatment for alleviating joint pain, call 020 8947 9524 to arrange a consultation at Mr Simon Bridle’s London joint replacement clinic.