Hip and Knee Questions and Answers.

Edited By: Seth S. Leopold, M.D.
Last updated Wednesday, February 09, 2005

Cortisone shots

Will a cortisone shot help delay hip or knee replacement surgery?

Cortisone (more properly, corticosteroid) injections into joints have been used to relieve arthritis symptoms--including pain, swelling, and inflammation--for over 50 years. Despite this, there have been surprisingly few well-designed scientific studies to determine which patients might benefit from this treatment, or how long the relief might last.

Just the same, cortisone shots are commonly used--and often are successful--in helping to relieve arthritis symptoms temporarily. Some patients are able to use them to get enough pain relief to hold off joint replacement surgery for months or even years. Cortisone shots are a treatment for pain; they do not alter the course of arthritis, and they do not cure the condition.

Many patients have fears about cortisone shots. Some common ones include:

• Will the cortisone shots cause bone or organ damage? (Answer: no).
• Will cortisone shots cause the arthritis to worsen or otherwise "ruin the joint"? (Answer: in reasonable doses, this has not been shown to be a problem).
• Are they very painful? (Answer: if the person doing the injection is skillful, generally not).

Injecting a knee joint with corticosteroids is a relatively straightforward procedure that, when done properly, takes only a moment and is not too uncomfortable. Relief is nearly immediate, because the cortisone usually is mixed with a local anesthetic, similar to Novocain used by the dentist; several hours later, the corticosteroid preparation will begin to have its anti-inflammatory effects on joint tissues. These effects can last anywhere from several days to 6 months or more. Most commonly, the relief lasts several weeks to several months. In view of this, many patients opt to try one or more cortisone shots before going ahead with a knee replacement. It is fairly clear that if one or two cortisone shots does not provide a reasonable level and duration of benefit, repeated injections are unlikely to be helpful.

In contrast, injecting a hip joint is difficult, and cannot be done reproducibly in the office setting. In order to make sure the needle will consistently find its way into the joint space of the hip, special radiology equipment like an ultrasound or fluoroscopy machine is needed. Having a hip joint injection is much more uncomfortable and inconvenient for the patient than having a knee injection. Also, for reasons that are not clear, hip joint injections seem not to work as well as knee joint injections. Perhaps for these reasons, nearly no research has been done on cortisone shots for hip joint arthritis, and most surgeons opt not to do them for the majority of patients with hip arthritis.

In summary, the potential advantages of cortisone shots for knee arthritis are:

1. They provide rapid onset of pain relief, which may last for weeks or months.
2. They are not too uncomfortable.
3. They are convenient.

The risks of cortisone shots are:

1. The risk of infection from putting the needle in the joint (which can be minimized by using careful technique); this risk has been listed as anywhere between 1 in 1000 and 1 in 16000, so the risk is not very great.
2. That repeated injections can cause a loss of skin coloration in the area where the shot was placed.
3. That occasionally the arthritis can flare up in the hours after a shot; this usually passes over the next day or so.

In any case, the best way to find out if this treatment for you would be to discuss it with a hip and knee arthritis specialist.

More information

For more information about hip replacement surgery, see this article.

Surgery for Hip and Knee at the University of Washington

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