Summary by Utah Sports and Wellness

Link to Original Article: https://pubmed.ncbi.nlm.nih.gov/31617798/

Radiology, Volume 29. December 2019. Boston University, School of Medicine. 59 References.

 

The study presents 5 cases of joint complications following corticosteroid injections:

  • Of the five cases studied, two were on the knee and three were on the hip.
  • Osteoarthritis is among the most common joint diseases affecting the hip and knee. This is expected to increase with extended life expectancy and obesity.
  • Injection of intra-articular corticosteroid is frequently performed to treat OA and other joint-related pain syndromes.
  • Despite the relative safety of IACS injections regarding systemic side effects, ‚Äúcorticosteroids can have adverse effect on cartilage, especially in higher doses.

Corticosteroids primarily affect cartilage proteins by mediating protein production:

  • A 2015 review of corticosteroid injections for knee OA involving 1,767 participants listed side effects after injection to include joint swelling, back pain, and joint stiffness.
  • A 2017 study evaluated structural changes in the knee with MRI and the response to IACS injections at 6 months, finding more severe meniscal damage and greater joint narrowing.
  • A 2019 study on IACS injection in the hip joint reported that 44% of patients who received them showed radiographic progression of OA and 17% developed articular surface collapse.

Other Key Factors:

  • Patients who received IACS injections had significantly more adverse joint events than a control group of patients without injections.
  • Published studies report adverse joint effects after hip and/or knee IACS injections, including accelerated osteoarthritis progression (OA), subchondral insufficiency fracture (SIF), and complications of osteonecrosis.
  • Large retrospective analyses and prospective studies evaluating (OA) or joint destruction after IACS injections are lacking.
  • 3 prior studies that dismiss the value of arthroscopic knee surgery have been reviewed. Taken together, these studies not only question the value of hip/knee corticosteroid injection and knee arthroscopic surgery, but raise concerns of harm.