Corticosteroid (Cortisone) Injections

Corticosteroid injections can temporarily reduce pain and inflammation in some people with knee osteoarthritis. However, the benefit is generally short-term, and research has raised concerns about their effects on joint structure over time. The American Academy of Orthopaedic Surgeons notes that corticosteroid injections can provide short-term relief, but specifically downgraded its recommendation because of the potential risk of accelerating osteoarthritis.

In a two-year randomized clinical trial, patients who received a triamcinolone corticosteroid injection every three months experienced significantly greater cartilage loss than patients who received saline injections, without a significant difference in knee pain over the study period.

A 2023 systematic review and meta-analysis involving 1,437 participants also found that intra-articular corticosteroid injections were associated with greater odds of worsening cartilage structure on MRI or X-ray. The authors concluded that corticosteroid injections may contribute to imaging evidence of cartilage loss, while noting that additional research is needed.

Because of these concerns, Arc of Life Medical Center does not use intra-articular corticosteroid injections as part of our treatment approach for knee osteoarthritis. We focus on evaluating the whole problem and discussing options based on the patient's findings, goals, evidence, expected benefits, limitations, and long-term joint health.

Research Highlight

A randomized JAMA trial compared corticosteroid injections given every three months with saline injections for two years. Cartilage thickness decreased by 0.21 mm in the corticosteroid group compared with 0.10 mm in the saline group, while there was no significant difference in knee pain between the groups.

1. McAlindon TE, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis. JAMA. 2017;317(19):1967–1975. View JAMA study

2. Ibad HA, et al. Longitudinal MRI-defined Cartilage Loss and Radiographic Joint Space Narrowing Following Intra-Articular Corticosteroid Injection for Knee Osteoarthritis: A Systematic Review and Meta-analysis. Osteoarthritis Imaging. 2023. View PubMed record

3. American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty) Clinical Practice Guideline. AAOS states that corticosteroids can provide short-term relief, but the recommendation was downgraded because of potential risk of accelerating OA.