James Dowd, MD
When living with painful arthritis, people are often hesitant to seek treatment, out of fear that surgery will be the first thing a physician recommends. When it comes to knee and hip osteoarthritis, there is a tried and true treatment that most orthopedic surgeons opt to try first because it is:
2. Almost painless
3. It works (most of the time, when used appropriately)
What is it? The corticosteroid injection, which is a medication that mimics the effects of the hormone cortisol. Cortisol is produced naturally in the body and helps regulate reactions of certain white blood cells involved in the immune response. Corticosteroids stimulate an immune response to control inflammation and reduce the irritation caused by bone interacting with bone. In other words, it helps relieve the symptoms caused by arthritis.
Why does it work? Arthritis may cause many different symptoms associated with inflammation. Osteoarthritis, in particular, most frequently presents with pain as a symptom. Osteoarthritis causes the smooth cartilage interface between joints to wear away, which gives credence to the term “bone-on-bone,” and can cause a great deal of pain and mobility issues. Corticosteroid injections are best for mild to moderate osteoarthritis because once the bone-on-bone state is reached, the injections simply don’t work as well for any length of time.
The corticosteroid shot is one of my favorite interventions because it is are easy to administer, almost painless, and they are usually successful at alleviating pain. I prefer to use a suspension type of medication that primarily stays located in the injected joint. We inject it into the joint, and the medication is present for about 4 or 5 weeks. It reduces inflammation and swelling, which are the chemical causes of pain. It can alleviate these symptoms for anywhere from just a couple of weeks to a year or longer.
I will also use these injections as a diagnostic tool. I may think that the pain is coming from a problem with your knee and you may think it’s coming from your back. If I give you the injection in your knee and you get symptomatic relief, that’s an indication that the symptoms were coming from your knee joint. We’ll do the same thing in the hip joint. With the hip, we usually have to use ultrasound or live X-ray to locate the hip and be sure that we’re in the correct space. Many things can masquerade as hip arthritis – back issues, bursitis, and more. If I give you a cortisone shot into your hip joint and you enjoy significant relief, your quality of life improves, and your symptoms subside, we can be pretty secure that the symptoms are indeed coming from the hip joint.
People often have stories of side effects or adverse events from the injections, but they are rare. Most commonly, people will have pain at the injection site, which is mitigated by ice, anti-inflammatory medication and a bit of time. Some people may have bruising around the site or color changes of the skin and every now and then, someone will have a hyped-up feeling, a lot of energy or couldn’t sleep the night of the injection. Generally, the shots are tolerated well.
The recommended frequency of shots presents a bit of mystery, as there is not a lot of evidence or science that supports a particular recommendation. We try to hold the frequency at no more than once every 3 months. If you are getting 3 -4 months of relief from a corticosteroid injection, it is well worth it to continue the injections until they seem not to be as helpful. On the flip side, if a shot is only offering about a month of relief, it is not truly making a significant difference in your quality of life. An injection may enable to you to be pain free for a vacation or a hunting season, but if the relief period is short, I would encourage you to think about long term solutions. If you have degenerative osteoarthritis, a knee replacement might be in your future. I can begin that conversation whenever you are ready. I would encourage you to look at your schedule so you can find a time that you can dedicate some resources to a more permanent cure/solution.
I find that corticosteroid injections shot may help you feel less pain, increase your mobility, and give you time to think about the possibility of surgery (if applicable). I encourage you to embrace the cortisone injection –it is a helpful tool to help manage symptoms and help diagnose the problem, and ultimately give you some time to perhaps take the next step in your overall treatment plan.