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It’s Official: Avoid Steroid Shots for Knee Arthritis!

POSTED ON IN Knee Latest News BY Chris Centeno

steroid shots for knee arthritis

Medicine changes slowly. It takes many years of research showing that a medication or surgery doesn’t work or is harming patients before most physicians who are used to the drug or procedure will drop it. However, there is a point in time that it becomes clear based on the evidence that it’s time to abandon ship. That moment just arrived for steroid injections to treat knee arthritis pain.

While it seems like I may be hammering on steroids this week, I can’t ignore study after study showing a multitude of reasons to stop, or never start, using them. Earlier this week I explained why even the short-term use of oral steroids is bad news; today it’s steroid injections again hitting my research radar, and they’re hitting it hard. I’ve known, for many years, about the negative effects of steroid shots on cartilage. However, sometimes patients’ desires for pain relief and insurance coverage outweigh their concerns for the risks. However, even more concerning, is the myriad of doctors who still don’t know that steroids can hurt joints.

New research published this week sought to figure out if steroid shots for knee arthritis were really helping the pain and if the side effects could be measured on imaging. Before I get into the new study, let’s first review some prior studies I’ve covered on the side effects of steroid injections.

The Side Effects of Steroid Injections: A Review

There are numerous side effects of steroid injections, but despite this, many patients get them following the advice of their physicians because they seem to make them feel better for a little while. Despite how commonly these shots are given, the research has been mounting that these injections damage tissue and potentially the body. Let me explain.

I’ve pleaded my case to physicians many times to stop injecting patients with high-dose steroids. Why? Both my observations and the research. For example, I’ve seen patients come into my practice whose arthritis I believe has accelerated due to steroid shots that were given months before. In 2013 I suggested that most patients really shouldn’t get steroids injected into their arthritic joints due to their deadly effect on cartilage.

It’s not just joints like the knee, doctors are also injecting steroids into tendons. One notable side effect is that steroids deplete stem cells, weakening the tendon. This fits with research that shows that in real patients with tendinitis, patients injected with steroids feel good for a while, but then the pain comes back worse than before.

Research has continued to support the negative effects of steroids on stem cells, showing that mesenchymal stem cells, which are the most common used to treat orthopedic issues, were wiped out by steroids. The interesting connection between that research and today’s feature study is that with the steroid triamcinolone (the one used in the new study below), just a small dose compared to what is usually injected wiped out all of the stem cells.

Another issue with steroids is how they impact the whole body. For example, one study showed a dramatic increase in bone loss in older women for each steroid injection. We’ve also seen studies that show disruptions in blood-sugar control, infections leading to hip replacement failure, and the list goes on. For example, another study also found adrenal insufficiency in subjects who had steroids injected into both knees.The negative side effects research has been so concerning that we began substituting platelet lysate for high-dose epidural steroid injections many years ago, with much better results.

New Research Shows Steroid Shots for Knee Arthritis Cause Cartilage Loss and Don’t Help Pain Better Than Placebo

The purpose of the new study was to compare the effects of the steroid triamcinolone to a placebo (in this case saline) on both knee cartilage and knee pain. The study was double-blind, meaning both the subjects and those administering it did not know if the subjects were in the steroid group or the placebo group, and injections were administered every 12 weeks for a period of two years.

The result? The steroid shot subjects experienced a progression of significant cartilage loss over the two years (double that of the placebo subjects), and the effect on their knee pain was not significantly different from that in the subjects in the placebo (the saline injection) group. Neither group achieved anywhere close to the minimal amount of pain improvement to be considered clinically significant. Research authors concluded that the use of steroid shots in the knee could not be supported as an effective treatment for knee arthritis.

The upshot? Patients typically undergo steroid shots for knee arthritis in the hopes of relieving their pain, but, unfortunately, the progressive side effect is further knee-cartilage loss. This leads to more pain and, hence, more steroid injections to temporarily relieve the pain until the next steroid injection. It’s a vicious cycle that this newest study shows is never-ending since the very drug doctors are injecting into the knee for pain relief (the steroid) is furthering the patient’s arthritis (the cartilage loss). So when will this silly practice end? At what point is the physician liable for malpractice because he or she ignored high-level research and injected a steroid into a knee, facilitating the destruction of the joint?

    *DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
    Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.

    comments

    Byron R Williams jr says

    When are you coming to Phoenix. I need hip replacement. Help.

    replies

    Chris Centeno says

    Bryon,
    We've had a Regenexx provider in Phoenix for years. Here is information on our alternative to Hip Replacement, however severe arthritis can require the cultured procedure done only in Grand Cayman. Please see: https://www.regenexx.com/the-regenexx-procedures/hip-surgery/ and https://www.regenexx.com/find-a-physician/

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    Dianne R says

    This is exactly what happened to me. I had perfectly healthy 18 year old cartilage in my 50s. I went to my orthopedic doctor for a patellar tracking problem in both knees that could be corrected with simple exercise. But in the meantime my doctor gave me many cortisone injections. 2 years later I was bone on bone. I was and am still absolutely horrified as I have no knee damage history. I became a cripple overnight. I pursued legal action against the drug company who makes the cortisone but it couldn't be proven unfortunately. Regenexx has helped tremendously to get my life back! I am back to hiking 3 days a week. Thank you Regenexx. You are a God send!!

    replies

    Chris Centeno says

    Diane,
    We hear that story time and again from patients...so glad your story had a happy ending!

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    RJ Rednour says

    It Would Certainly Appear to Me That This "Practice" MUST STOP NOW !
    Where Are the GOOD LAWYERS !!!
    Class Action Is The Required Remedy,
    Or This Obvious Charlatan Malpractice Continues Unabated !
    FULL DISCLOSURE NOW - The Entire Medical Establishment Is Libelous .

    replies

    Mike Smith says

    Is this type of treatment covered by most insurance companies ?
    Thanks, Mike
    P.S. Do you have a center in Spokane, WA.

    replies

    Chris Centeno says

    Mike,
    These types of procedures are not covered by Health Insurance, yet. These are the types of issues in the way: https://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/ We've had good success in getting these procedures covered with entities that have a vested interest in the outcome, like Employer Self-funded Health coverage and Medical Cost-sharing plans. We have 2 Regenexx Providers in Washington. Our Spokane Provider currently treats the Spine only. Please see: https://www.regenexx.com/find-a-physician/

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    than nguyen says

    Does the same apply to steroid shots for cervical disc herniations? I have so much pain in my neck and I'm considering getting a steroid shot in the neck.

    replies

    Chris Centeno says

    Yes

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    Janet F. says

    I have had cortizone injections for a miniscus tear that lead to surgery on left knee. That led to osteoarthritis which is now bone on bone. Now I’m reading that surgery for miniscus tears are not recommended as they cut out too much cartilage leading to further pain. Now my knee is unstable, can buckle on me and cause severe pain in my entire leg. Now they want to do knee replacement or more shots. I don’t want either. Do you know of any dangers of injecting hyuralonic acid into knee? I can’t afford the stem cell treatment unless you do payment plans. But I cannot walk long with my knee in this condition.

    replies

    Regenexx Team says

    Hi Janet,
    Very unfortunately, your case is very typical. Please see: https://www.regenexx.com/blog/knee-meniscus-surgery-causes-arthritis/ Most patients do well with hylauronic acid (Synvisc). It's basically a lubricant. The one issue is because it's made from rooster combs, tell your doctor if you are allergic to products from birds such as feathers, eggs, or poultry as Synvisc may cause an allergic reaction. For knee treatment please see: https://www.regenexx.com/conditions-treated/knee/ Many of our Clinics work with various forms of payment. Please call 855 622 7838 for more information.

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    Frank Belcher says

    I had stem cell transplant from hip to "end stage" shoulder joint 10 yrs. ago at Centeno-Schultz clinic by Dr. Schultz. Now 83 yrs. old and both shoulder joints giving considerable pain a few hours after lifting over 40 lbs. such as 5 gal, can of generator gas. I live off the grid - rely on solar and generators for electricity (retired cattleman).
    Stem cell transplant worked well ! Problem is now retired and low income - I have Medicare and Medicare supplement plan F that pays for any kind of surgery 100 % but not for stem cell transplants such as I had to pay from savings at age 73. So now at 83, what next ? Double shoulder joint replacements ? Also one knee starting to act up. I walk briskly 1 mile a day in circle around my yard, sometimes 2.

    replies

    Regenexx Team says

    Hi Frank,
    Something significantly less expensive like Prolotherapy may help and likely worth a try before considering double shoulder replacements at 83. Give us a call at 303 429 6448.

    replies

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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