Cortisone shots can give great pain relief for arthritic knees and hips, but they are not necessarily the best for every patient in every situation. Every year, many people have cortisone shots, also known as steroid shots, to relieve the pain and inflammation caused by arthritis. Cortisone shots can also improve function and increase your ability to exercise and participate in activities of daily living. However, cortisone shots are not necessarily the best option for every patient in every situation. Here are some important things to know:
Not Always “Cortisone.”
Cortisone is part of a family of steroids called corticosteroids. There are many different types, but common ones include dexamethasone, depo-medrol, and kenalog. They are all very similar and your provider may prefer one or sometimes a combination of two.
Targeted Anti-Inflammatory Effect
Corticosteroids are powerful anti-inflammatory medications. They are sometimes given as pills, which may sometimes cause side effects such as weight gain, blood sugar elevations, or agitation. However, when injected directly into the knee or hip joint, they can provide targeted, rapid pain relief with minimal exposure to the rest of your body.
Cortisone shots usually take a few days to reach their full effect. They are often combined with a numbing medication such as lidocaine to provide relief before the cortisone starts working. Most patients get relief for a few months, but the shots can wear off sooner or later depending on the severity of the arthritis. There is no shot or pill that can reverse the cartilage damage done by arthritis, but cortisone shots can help the pain.
Possible Side Effects
One could think of cortisone similar to “candy for the knee.” It will make the knee feel good for a few months, but it is probably not healthy to have too much. Most providers recommend waiting a few months before considering a repeat shot. Cartilage damage, bone death, joint infection, and nerve damage are all possible, but rare side effects. When done by an experienced provider, these complications are all exceedingly rare. More common, but still rare and temporary side effects can include facial flushing, inflammation of the joint, and skin lightening. Patients with diabetes may notice their blood sugar levels rise temporarily.
Some Do Better Than Others
Some patients experience better pain relief than others. In cases of minor arthritis, some patients report years of excellent relief. On the other hand, pain control is unlikely to last more than a few weeks for patients with severe bone on bone arthritis. Repeated injections tend to work less well than the first. However, in patients who are not candidates for hip or knee replacement, repeated injections may be one of few options.
A Little Pinch
Shots in knees and hips are generally not unbearable. To minimize the pain, your provider may use a small needle, as well as topical numbing spray. The seconds it takes to give the injection is often worth the months of relief!
Cortisone is only one of several different types of injections for hip and knee arthritis. Other options include hyaluronic acid (aka “gel" shots), platelet rich plasma (PRP), as well as orthobiologic treatments. The pain relief and research on cortisone is often the strongest in most patients, but other shots might be an option to delay surgery in the appropriate patient.