Cortisone Injection for OA Knee Pain

Posted by Helen Potter on 23 December 2019 | Filed under OA Knee

17 February 2018 Modified by Helen Potter FACP

Corticosteroid injection is approved as an adjunct, short-term treatment for pain relief in patients with knee osteoarthritis (OA). But repeat injections or long-term use are not supported by current evidence.

Repeated injections lead to cartilage loss and do not reduce pain in patients with knee OA (Osteoarthritis).

Key points

In a 2-year clinical study cortisone did not reduce pain for patients with Knee OA.
Any reduced pain was moderate at 1–2 weeks, minimal at 13 weeks and not evident at 26 weeks.

  • Management of OA should aim to optimise the patient’s physical function with a physiotherapy rehabilitation program
  • This should emphasise strength and specific VMO with retraining of motor control
  • Physiotherapy aims to maximise quality of life by encouraging weight loss and increased activity
  • We use education and current knowledge to enable you to cope with pain
  • We reduce symptoms with active physiotherapy and specific retraining of knee and hip muscle control
  • We  cam improve movement and function

 A diagnosis of knee OA is almost 100% likely if you have all of the following signs and symptoms:

  1. Persistent activity-related knee pain
  2. Morning stiffness
  3. Reduced function - sitting to stand, walking, dressing etc
  4. Crepitus/noise on movement
  5. Restricted knee movement, inability to squat, go up and down stairs
  6. Bony enlargement seen visually and felt on palpation.

Knee OA can be diagnosed using these typical features, without X-ray or MRI. Although age of onset, symptoms and progression of OA will vary between patients, there are several ‘typical features’ of OA. 

  • Age > 40 years
  • Activity-related joint pain ie it hurts when you move and may ache afterwards
  • Short duration of (or no) morning stiffness (< a half hour)
  • Symptoms affect only one or a few joints

MRI should be considered only if there is suspicion of serious pathology not detected by X-ray as radiological features of OA typically have a low correlation to OA symptoms. Some X-RAYS reveal severe damage in people who don't have knee pain. Other knees can look normal on MRI despite marked difficulty with function.

How should knee OA be managed?

  1. Analgesics should be recommended to help enable physical function rather than to abolish pain
  2. Although management will differ for each individual –  evidence proves that weight management and exercise are effective
  3. Intervention should be assessed regularly against individual goals to determine whether you are improving

Cortisone

If required for pain relief short term:

  • Should be no more than four injections in a single joint in a year, because of  increased risk of cartilage damage
  • If no response after two consecutive injections, do not repeat
  • A single injection may provide symptom relief lasting 4–12 weeks for patients with knee OA
  • In research, steroid injections in patients with knee OA were found to lead to small or moderate improvements in knee pain which enables exercise

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