Cartilage Degeneration and Risks of Corticosteroid Injections After introduction and comparison of corticosteroid agents , we are now going to move into reviewing the complications common with corticosteroid injections.
Cartilage Degeneration and Risks of Corticosteroid Injections After introduction and comparison of corticosteroid agents , we are now going to move into reviewing the complications common with corticosteroid injections. As mentioned previously, corticosteroid injections were first documented in the 1950s and have become a staple of office based orthopedic management. Many orthopedic practices in the United States will perform injections in 3-month intervals or more spaced out if possible.
The main reasoning behind the limitation of injections is preservation of cartilage and avoidance of side effects. There is contrasting evidence regarding repeated corticosteroid joint injections and cartilage damage. Two studies in the 1960s and 1970s concluded that repeated steroid injections do not lead to rapid cartilage destruction or advanced joint space narrowing [1, 2].
A study in 1986 showed a decrease in proteoglycan content in synovial fluid and questioned these studies. Proteoglycan content are molecules that are degraded and released from synovial fluid during osteoarthritis of synovial fluid. There are multiple studies in animal models (mice, rats and rabbits) that suggest intra-articular corticosteroids do lead to cartilage damage and the term hydrocortisone arthropathy emerged in the 1960s and 70s [4, 5, 6, 7.] Studies in humans have been inconclusive and the frequency used today is based on professional opinion.
Throughout the 1990s and 2000s, the ranges recommended repeat injection from 6 weeks to 6 months but many suggested 8-12 weeks with weight-bearing joints [ 8 , 9 , 10 , 11 ]. A more recent study in 2017 by McAlindon showed that patients receiving triamcinolone injections every 3 months for 2 years had greater cartilage loss on MRI compared to those injected with saline in 140 patients with knee OA [ 13 ]. This has led some providers to question the current standards [ 22 ].
Up to five percent of injections will have a postinjection flare, or a localized inflammatory response that typically arises within 24 hours and resolves around 48 hours to 72 hours. Some have proposed this to be chemical synovitis in response to insoluble steroid crystals. Symptoms can range from small joint effusion to disabling pain.
If you are experiencing symptoms that may be related to frequency, cartilage loss and common complications of corticosteroid injections, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
Connect with a doctor, physical therapist, or imaging center near you.
Find a Provider Near You โ