Are Cortisone Injections Good or Bad for Arthritic Knees?

Are Cortisone Injections Good or Bad for Arthritic Knees?

Cortisone injections have gotten a bad rap in recent years as a treatment for arthritis pain, because steroids are known to damage cartilage and could potentially cause the joint to further deteriorate.

But a new study suggests that if used wisely, cortisone shots are as safe as another type of injection used to treat knee arthritis.

Occasional cortisone shots don’t appear to cause knees to deteriorate any faster than injections of hyaluronic acid, a substance injected to lubricate joints stiffened by arthritis, the researchers said.

“Knee replacement rates were, if anything, a little bit less in the group that got the cortisone injections,” said senior researcher Dr. David Felson, a professor of medicine and epidemiology at Boston University School of Medicine.

However, Felson added that the study only looked at people who’d gotten infrequent cortisone shots to their knee, and shouldn’t be interpreted as giving the green light to regular injections for years to come.

“What we know from the study that we can trust is that a few cortisone injections won’t really cause much trouble,” Felson said. “It’s conceivable that repeated injections every three months for years won’t cause any trouble, but you can’t say that.”

Steroids are known to be toxic to cartilage, the connective tissue that keeps your bones from rubbing against each other, explained Dr. Melissa Leber, director of the Emergency Department’s Division of Sports Medicine in the Icahn School of Medicine at Mount Sinai in New York City.

“If you use it enough, it will damage the cartilage,” said Leber, who had no role in the study.

A 2019 study reported a threefold increased risk of knee arthritis progression in people who’d received repeated cortisone injections, compared with people who’d never gotten the shot, Felson and his colleagues said in background notes.

Comparing two types of shots

However, no clinical trials had ever compared the two most common types of knee arthritis injections, cortisone jabs and hyaluronic acid shots, Felson said.

The two types of shots do different things in the joint, and are sometimes used in combination, Leber said.

Cortisone shots are anti-inflammatory and help reduce pain, while hyaluronic acid injections are like a gel that provides lubrication in the ailing joint.

“You’re injecting WD40 almost into the knee. That acts to allow smoother gliding in the joint,” Leber explained.

Unlike cortisone, hyaluronic acid gel isn’t harmful to cartilage.

The latest study looked at nearly 800 people with knee arthritis, of whom 4 out of 5 reported getting cortisone shots for their knee pain. The rest had reported receiving hyaluronic acid injections.

After seven years of follow-up, researchers found that those who got steroid injections had no greater cartilage loss than those treated with hyaluronic acid.

In fact, people who got cortisone shots were about 25% less likely to need a total knee replacement than those who got hyaluronic acid.

The message to knee arthritis patients regarding cortisone shots is simple, Felson said: “Don’t be scared.”

“There’s nothing bad that’s going to happen with one shot or even a few shots,” Felson said. “People should be reassured. They shouldn’t avoid getting an effective treatment.”

Wise use is crucial

The findings bolster the approach orthopedic specialists already take in handing out cortisone shots to treat knee arthritis, Leber said.

“If someone already has a ton of damage to the cartilage in their knee, a lot of arthritis, then we don’t worry as much about using a steroid to help with pain control because they already have a lot of arthritis in the knee,” Leber said. “Damaging it a touch more just to give them good pain control is a very minor thing. It’s not as risky.

“In someone who’s young, in their 20s to 40s, who has very little cartilage damage but has pain, we try to use it sparingly,” she continued. “Would you use them on occasion in a young person? Yes. That’s only as a one-time thing. You don’t want to use it repetitively.

“Steroid is bad for cartilage, but that doesn’t mean it’s bad for every patient,” Leber concluded. “It’s a case-by-case situation.”

Regardless, you wouldn’t expect any patient to receive frequent cortisone injections, whatever their condition, added Dr. Jeffrey Schildhorn, an orthopedic surgeon with Lenox Hill Hospital in New York City.

“If you give someone a shot in January and they come back in April saying they want another one, and they come back in August and want another one, how well are they working?” said Schildhorn, who was not part of the study. “They’re not working, if you’re only getting two or three months of relief.”

The new study was published recently in the journal Arthritis and Rheumatology.

More information

The Cleveland Clinic has more about knee arthritis.

SOURCES: David Felson, MD, professor, medicine and epidemiology, Boston University; Melissa Leber, MD, director, Emergency Department’s Division of Sports Medicine, Icahn School of Medicine at Mount Sinai, New York City; Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, New York City; Arthritis and Rheumatology, Dec. 1, 2021

Copyright ©2022 HealthDay. All rights reserved.
Preventing Common Winter Orthopedic Injuries

Preventing Common Winter Orthopedic Injuries

Winter is a great time to get outdoors — but it can carry some unexpected dangers if you aren’t careful. Find out how to prevent common winter injuries so you can head outside safely!

Although some people prefer warmer temperatures, many spend the year waiting for the time it gets cold enough to take part in all of winter’s unique pleasures. From winter sports to brisk walks to snowball fights, there’s a lot to enjoy during the colder months. Unfortunately, along with the snow and ice comes a greater chance of orthopedic injuries.

When people think about winter injuries, they tend to focus on the ones tied to sports, like skiing and snowboarding. While there’s no denying that those activities can lead to orthopedic injuries (a study by Johns Hopkins University in 2012 estimated 10 million Americans ski or snowboard, with approximately 600,000 injuries reported each year), you don’t have to glide down a mountain to be at risk. The U.S. Bureau of Labor Statistics recorded 20,460 ice, sleet, and snow-related injuries for workers in 2017 alone.

And it’s not just adults who are at risk. Children who toboggan down hills can get hurt, too. Between 2008 and 2017, 220,488 patients received treatment in emergency rooms due to sledding related injuries, a study conducted by researchers at the Center for Injury Research and Policy at Nationwide Children’s Hospital. Roughly 70 percent were children under the age of 19.

Common Non-Sport Winter Orthopedic Injuries

The snowy and icy conditions that often accompany the cold weather of winter can cause a number of injuries even if you stay far away from the slopes. Slips and falls are particularly common examples. Fortunately, most only result in bruises. But some falls can severely injure vulnerable ligaments or bones — something that becomes particularly dangerous as you get older. Even if you don’t fall, a sudden wrenching of your knee while walking over ice can sprain or tear a ligament like the anterior cruciate ligament (ACL) or meniscus, two important ligaments in the knee.

Shoveling snow is another common winter activity that has some risks. Whether from your sidewalk or off your car, shoveling snow puts enormous pressure on your lower back muscles and spine that can lead to pulled muscles or herniated discs. Plus, shoveling can leave behind icy patches that are difficult to see, but can lead to serious slips and falls.

Preventing Wintertime Injuries

Fortunately, you can still enjoy your wintertime activities (and chores) safely as long as you take precautions and know your limitations.

On The Slopes

Prepare for Your Run. Before you hit the slopes, take time to ready your muscles for the workout. Weight-bearing and resistance exercise strengthen the muscles and connective tissues you rely on when you ski. And no matter how much exercise you’ve done beforehand, always stretch and warm up prior to your run. Cold muscles injure more easily.

Wear the Right Equipment. Check your equipment, such as skis, snowboards, and boots, to ensure they fit properly and are in good condition. Ill-fitting equipment often leads to falls. And always wear a helmet to protect your head in case you take a spill against the hard snow or ground. Helmets are also a great option for children sledding down a hill.

Take a Safety Course. Even experienced skiers benefit from a remedial course on ski safety. An instructor can show you how to fall properly so you avoid a serious injury.

Around the Home

Clear Your Pathways. Shoveling removes the snow, but it can leave behind icy patches that may not be visible to the naked eye. To ensure nothing slippery remains, salt and sand your pathways and steps repeatedly to melt away any residual ice.

Shovel the Right Way. No one likes to shovel snow, but it’s an unfortunate reality of living in snowy regions. You can cut down on your chance of an injury by shoveling the right way. Always stretch before you shovel and make sure to only move small amounts of snow at a time. When you can, push the snow instead of lifting it, and when you do lift, make sure to do it with your legs not your back. If you feel tired, stop and rest.

Walk Carefully. It’s easy to lose your balance and take a spill on ice or snow. To avoid a fall, take slow, small steps over terrain where you’re unsure if there is black ice. When outdoors in winter, wear footwear with sturdy rubber soles for better traction. And don’t carry heavy packages that could cause you to lose your balance and tip over. Wherever possible, keep your hands free to better catch yourself in case of a fall.

Treating Common Winter Injuries

While serious injuries, like broken bones, must be treated in an emergency room right away, most common wintertime injuries can be treated at home with ice or heat, over-the-counter pain medications, and rest. But sometimes that’s not enough. If the pain persists or you think you may have severely injured a ligament, it’s important to see an orthopedist right away. The physicians at Comprehensive Orthopaedics can diagnose your injury and prescribe treatment to help you feel better.

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