In this article, we describe all the benefits and risks of cortisone injections in the knee and provide information about safer and more effective alternatives, including an advanced treatment called Prolotherapy.
What Is Cortisone Injection?
Cortisone injections, also known as corticosteroid injections, are medications that can alleviate joint pain and swelling in specific locations of the body. Most frequently, they are injected into the joints of the knee, wrist, spine, elbow, hip, and ankle. Cortisone injections can also be used in smaller joints, such as toes and fingers, to help relieve pain[1].
These injections provide rapid relief, often lasting for weeks to months, making them a valuable option for managing chronic pain conditions. For example, facet joint injections target the spine to alleviate pain caused by arthritis or other injuries.
Cortisone shots are particularly beneficial for treating inflammatory forms of arthritis, such as rheumatoid arthritis, and may also be prescribed for back pain, gout, knee osteoarthritis, bursitis, psoriatic arthritis, and tendinitis.
Typically, cortisone injections contain a corticosteroid and a local anesthetic. Due to potential side effects, the number of cortisone injections per year is often restricted.
How Do Cortisone Shots Work?
When cortisone is injected directly into the site of swelling—typically joints or tendons—it suppresses immune system components, reducing pain and swelling. While steroid injections are effective for pain relief, they often do not treat the underlying condition. For example, cortisone injections for osteoarthritis may relieve inflammation but do not rebuild damaged cartilage[2].
In some cases, such as De Quervain’s tenosynovitis, a single injection can permanently resolve the condition[3]. Overall, corticosteroid injections can promptly reduce joint pain and inflammation, with effects lasting from weeks to several months.
What’s The Procedure For A Cortisone Shot?
The procedure is typically performed by orthopedic doctors. You may be asked to wear a hospital gown, depending on the area being treated. The doctor will clean the injection site, apply a numbing agent, and insert a thin needle into the affected joint. Most people feel only mild pressure or brief discomfort during the procedure.
How Does It Feel To Receive A Cortisone Shot?
No special preparation is needed, but if you use blood thinners, you may need to stop them temporarily (always consult your doctor first)[4]. If you have diabetes or an infection, consult your doctor before receiving a cortisone shot[5].
The sensation depends on the injection site. Injections into larger joints are usually less painful than those into delicate tissues. Lidocaine provides quick numbing, while the steroid may take several days to take effect.
What Are the Risks Associated With Cortisone Shots?
Cortisone shots can cause minor or serious side effects, depending on the site and frequency of administration. Common minor side effects include pain, redness, and swelling at the injection site, usually resolving within 48 hours.
Weakened Immunity
Cortisone can weaken the immune system, increasing the risk of infections and, rarely, autoimmune conditions. Most doctors recommend limiting cortisone injections to one every three months per joint, and no more than six per year for the entire body[6].
Raised Blood Sugar Levels
Cortisone can increase blood sugar levels, especially in people with diabetes. Blood sugar should be monitored before and after the injection.
Osteoporosis Risk
Steroid injections may occasionally induce osteoporosis, a condition characterized by reduced bone density.
Infection Risks
There is a risk of infection at the injection site. Signs include warmth, redness, swelling, fever, and pain. Seek medical attention immediately if you notice these symptoms.
Other Side Effects
Other possible side effects include allergic reactions, headaches, facial flushing, fat necrosis, hypopigmentation, thinning of the skin, fluid retention, mood changes, and high blood pressure.
Repeated Cortisone Shots: Cartilage and Soft Tissue Damage
Repeated steroid injections in the same joint over a short period can damage cartilage and soft tissues such as ligaments and tendons. Doctors recommend waiting at least three to four months between injections and limiting to three or four per year in the same location[7].
Patients using other corticosteroid medications should receive fewer injections or lower doses to minimize risks[8].
Cortisone Shots as Part of a Comprehensive Treatment Plan
Steroid injections offer short-term relief[9]. For long-term improvement, patients are encouraged to:
- Participate in physical therapy to strengthen muscles and improve joint function.
- Lose excess weight to reduce joint stress.
- Make lifestyle changes, such as regular physical activity and changing footwear.
- Use NSAIDs for temporary pain relief.
These measures can enhance joint biomechanics and reduce the need for repeated steroid injections.
What about Hyaluronic Acid Injections?
Hyaluronic acid is a natural component of healthy knee fluid. In osteoarthritis, its levels decrease. Doctors may inject hyaluronic acid to supplement the joint, providing cushioning and lubrication. Studies show that hyaluronic acid injections may be as effective as cortisone for some patients, especially when other treatments have failed.
Hyaluronic acid injections are not usually the first line of treatment but may be considered if physical therapy, NSAIDs, or cortisone are ineffective or contraindicated. Multiple injections may be required over several weeks.
Prolotherapy: An Alternative to Cortisone Injections
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat knee pain. Published research has proven its pain-relieving, anti-inflammatory, and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This stimulates the production of collagen cells, which are essential for repairing damage and supporting knee health.
As prolotherapy addresses the root cause of knee pain, it is considered a permanent solution, preventing symptoms from returning.
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Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating knee pain, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with knee pain and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
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FAQs
How Long Does A Cortisone Shot Last In The Knee?
Typically, the effects last up to two months, but can sometimes continue longer. Cortisone shots help minimize joint-damaging inflammation. Your doctor may also offer other treatments for joint pain arising from ligament or tendon injuries, excess weight, or autoimmune problems.
How Long Does It Take For A Cortisone Shot In The Knee To Work?
Steroid treatment often takes between 3 and 7 days to begin to exert its beneficial effects. It may take up to two weeks for the medication to reduce inflammation sufficiently to alleviate discomfort. The full effect may not be felt until six weeks after injection.
What Is The Downside Of A Steroid Injection?
Frequent administration of steroid injections may cause cartilage damage within a joint. Doctors limit the amount of cortisone injected into a joint—no more frequently than every six weeks and typically no more than three or four times a year.
What are the differences between steroid injections and cortisone injections?
In the context of orthopedic diseases, both steroid and cortisone injections refer to the same substance. Both are effective in relieving pain and reducing inflammation.
What To Expect After Receiving Steroid injection in the knee?
After receiving a steroid injection, you may notice minor side effects such as swelling and pain in the joint, which usually resolve within two days.
References
- Martin SD, Conaway WK, Lei P. Use of Intra-Articular Cortisone shots in Orthopaedics. J Bone Joint Surg Am. 2018 May 16;100(10):885-891. doi: 10.2106/JBJS.17.00289. PubMed PMID: 29762289.
- Osteoarthritis Foundation. https://www.arthritis.org/living-with-osteoarthritis/treatments/medication/drug-types/corticosteroids/corticosteroid-injections.php. Accessed July 20, 2019. Joint injections (joint aspirations). American College of Rheumatology.
- Use of Cortisone shots in pain and swelling Osteoarthritis. (osteoarthritis.org/living-with-arthritis/treatments/medication/drug-types/corticosteroids/corticosteroid-injections.php) Accessed 4/16/2018. American Society for Surgery of the Hand. Steroid Injections.
- Bellamy, N., Campbell, J., Welch, V., Gee, T. L., Bourne, R., & Wells, G. A. (2006). Intraarticular cortisone shots for treatment of osteoarthritis of the knee. Cochrane Database of Systematic Reviews, (2).
- Arroll, B., & Goodyear-Smith, F. (2004). Corticosteroid injections for osteoarthritis of the knee: a meta-analysis. BMJ, 328(7444), 869.
- da Costa, B. R., Hari, R., & Jüni, P. (2016). Intra-articular corticosterone shots for osteoarthritis of the knee. Jama, 316(24), 2671-2672.
- Jüni, P., Hari, R., Rutjes, A. W., Fischer, R., Silletta, M. G., Reichenbach, S., & da Costa, B. R. (2015). Cortisone shots for knee osteoarthritis. Cochrane Database of Systematic Reviews, (10).
- Hepper, C. T., Halvorson, J. J., Duncan, S. T., Gregory, A. J., Dunn, W. R., & Spindler, K. P. (2009). The efficacy and duration of cortisone shots for knee osteoarthritis: a systematic review of level I studies. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 17(10), 638-646.
- Kullenberg, B., Runesson, R., Tuvhag, R., Olsson, C., & Resch, S. (2004). cortisone shots: pain relief in osteoarthritis of the hip?. The Journal of Rheumatology, 31(11), 2265-2268.