Steroid Injection In The Knee
A painful or swollen joint can gravely limit movement and interfere with daily tasks. Lower limbs are more prone to developing issues owing to the weight-bearing nature of the joints. A relatively common joint pain is knee pain.
According to a community-based cross-sectional study, the prevalence of knee pain was found to be 46.2%. The numbers increased with increasing age and weight gain. Diagnosing the underlying cause of joint inflammation and pain is crucial to offer proper treatment.
The intensity of joint pain varies between individuals. Some might experience slight discomfort and immobility, while others moan in intense pain. Healthcare professionals across the globe offer multiple treatment modalities for pain relief.
Steroid treatment (steroid injections) is a potent way to relieve pain. The main aim of all treatment strategies is to reduce inflammation and relieve pain.
There are different types of steroid injections used for different purposes. Bodybuilders frequently use anabolic steroids to enhance muscle mass, but only a hydrocortisone injection is the ideal choice for alleviating increased pain.
Painful Knee Conditions That Call For A Steroid Injection
There are multiple knee conditions that validate the use of steroid medicines. Your healthcare professional can advise steroid injections for different inflammatory arthritis conditions.
According to a survey, approximately 46 million US adults suffer knee pain due to multiple factors. Whatever the underlying cause of joint pain, steroid injections are considered efficacious and effective in relieving pain. Steroid injections are frequently used in sports medicine due to the high frequency of injuries (sports injuries).
Common examples of inflammatory arthritis conditions include osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, gouty arthritis, ankylosing spondylitis, etc.
Knee Osteoarthritis
Osteoarthritis (osteo-bone, arthritis-inflammation) is a degenerative condition affecting thousands of old individuals yearly. As of 2016, the worldwide prevalence of this joint disorder was found to be 28.7%. Knee osteoarthritis pain is a common form of knee pain for which patients seek treatment.
Knee osteoarthritis is characterized by intra articular joint damage. The articular cartilage (present in the knee joint) wears away, causing pain and swelling in the affected joint. Your doctor will categorize knee osteoarthritis into four stages:
- early
- mild
- moderate
- severe
Efficacy Of Steroid Injections For Knee Osteoarthritis
Enhances Mobility
The cartilage breakdown calls for corticosteroid injections to achieve pain relief. A consultant rheumatologist and orthopaedic surgeon will guide you about the necessary lifestyle changes and hydrocortisone injection therapies to help improve symptoms in knee OA patients.
According to a meta-analysis of randomized controlled trials, intra articular corticosteroid injections alleviate pain and enhance mobility. Knee osteoarthritis patients receiving repeated injections reported increased confidence.
Provides pain relief
Steroid injections are now a common treatment for joint pain and inflammation. As per a 2021 study, only one injection (intra articular injection) of steroids can relieve pain. However, a better analgesic effect is achieved if the steroid injection is combined with a local anaesthetic. Most of the studies validate the use of corticosteroid injection for the short term.
has Long-term effects
Research shows that steroid injections can also be efficacious for long-term management of knee OA. The results of a randomized controlled trial revealed that steroid injections administered every 3 months for 2 years could have positive outcomes in symptomatic knee OA patients. No deleterious effects on the joint were observed during the study.
Total knee replacement
Individuals undergoing total joint replacement due to severe knee osteoarthritis suffer from recalcitrant pain. Your health professional will prefer to give steroid injections to treat the pain. Studies show that intra articular injections of steroids significantly reduce joint pain.
Rheumatoid Arthritis
Another commonly encountered inflammatory arthritis condition of pain and swelling in the joints is rheumatoid arthritis. It is an auto-immune disease that leads to intra articular inflammation and pain. The disease is characterized by periods of exacerbations (flare up) and remissions.
A faulty immune system produces autoantibodies. These antibodies attack bones, joints (intra articular region), and associated soft tissue.
The main aim of a doctor’s treatment is to provide pain relief. Disease-modifying antirheumatic drugs (DMARDs) are the mainstay of the treatment. However, symptomatic management revolves around reducing inflammation.
Acute inflammation of the intra articular joint (of the knee) does not generally respond to common analgesic treatment strategies. Therefore, steroid injections are preferred in moderate to severe cases. Your health professional will determine when steroid injections start.
Efficacy Of Steroids For RA
Intra articular injection of steroid medicines paired with hyaluronic acid provides appreciable pain relief in RA patients with knee pain. The combination of medicines is better than a steroid injection alone.
Helps Manage juvenile rheumatoid arthritis
Different corticosteroid injections are employed to reduce inflammation and knee joint pain. Juvenile rheumatoid arthritis is RA of the young. One study revealed that injecting triamcinolone hexacetonide showed results superior to steroid injections of triamcinolone acetonide.
The American College of Rheumatology authorizes using steroid injections to manage rheumatoid arthritis (in the knee) but only in small quantities (high doses are not recommended). According to the organization, early steroid injection use can provide systemic relief in addition to the local effect on the affected joint. The steroid injection therapy covers both glucocorticoid and hydrocortisone injection types.
reduces the size of RA Nodules
Rheumatoid arthritis is characterized by the formation of RA nodules on the skin. Survey shows that steroid injections not only reduce inflammation but also reduce the size of these nodules.
Ankylosing Spondylitis
It is not uncommon to find knee pain in ankylosing spondylitis patients. Your doctor might miss the signs and symptoms of the disease in general practice. Therefore, diagnosing this condition based on a swollen joint is a specialist’s job (consultant rheumatologist).
In some cases, the knee joint is the affected area which calls for intervention. The main aim of every doctor is to treat the condition with non-steroidal analgesics and other medicines of a similar kind. However, a steroid injection is the only potent treatment for severe pain.
Ankylosing spondylitis is an autoimmune disorder in which autoantibodies destroy the vertebrae and other joints of the body (including the knee, hips, and wrist joints, etc.). Symptoms include swelling and pain in the affected area. There is currently no treatment available for the disorder.
Efficacy Of Steroids For Ankylosing Spondylitis
Steroid injections are given to treat the peripheral symptoms of the disease (which predominantly include hip and knee joints). Studies suggest that a local steroid injection should be tried before going for other medicines (TNF blockers).
Corticosteroid Injections For Knee Pain
A consultant rheumatologist or an orthopaedic surgeon is a doctor that deals with joint and soft tissue diseases. Your doctor may advise multiple steroid injection sessions to achieve the knee joint’s desired anti-inflammatory status.
How Is A Steroid Injection In Knee Administered?
There are different approaches to administering a steroid injection in the knee. The doctor first examines the affected joint and selects the site. Most doctors prefer lying the patient on the back. However, you may be laid down on your back or seated comfortably before the doctor begins.
Steroid injections are generally small, and needles are fine. So the patient doesn’t feel much discomfort during the procedure. Before injecting the steroid medicines (hydrocortisone injection), the doctor (orthopaedic surgeon or consultant rheumatologist) sterilizes the injection site.
Then a numbing agent (local anaesthetic) is applied to the skin of the knee. The local anaesthetic is usually in the form of a spray or an injection.
In a few cases, the doctor removes a small amount of fluid from the joint. This maneuver is done to make space for the steroid injection. The injection is administered at the same joint site from where the joint fluid is removed.
Some healthcare professionals prefer to give steroid injections with ultrasound imaging guidance. This allows for better and more accurate needle positioning in the injection site. In both cases injection needle is carefully inserted into the knee joint (intra articular region), and the steroid medicines are injected directly into the intra articular region. You might feel slight discomfort during the procedure but nothing significant.
Your healthcare professional will place a small sterile dressing for the injection site (on the same joint) after the injection.
Duration Of The Procedure
It is a quick procedure that does not require you to leave from work. Most intra articular steroid injections in the knee are completed within 5 minutes. The duration can be slightly longer if ultrasound is used for guidance.
How Much Pain Is Felt During The Procedure?
Luckily, a knee steroid injection is not very painful. Just like any other injection, you will feel a slight pinch of a needle which is largely defined as uncomfortable rather than painful.
You might notice slightly increased pain and swelling in the knee joint immediately-to-a few hours after the injection, but this is only temporary and goes away after a few days. This rise in pain is known as “steroid flare up” which lasts for 48 hours.flare t
How Long Does It Take To Become Free Of Joint Pain?
Steroid injections start lowering pain and swelling within a few days to a few weeks time. You will not need repeated hydrocortisone injection sessions if you achieve desired pain relief from one intra articular injection.
How Long After The Injection Will I Stay Painfree?
The injection duration depends on the disease severity, the treatment plan of your healthcare professional (type of steroids chosen), and the affected joint. With a steroid injection in the knee, you can expect to stay clear of symptoms (swelling and pain) for several months. Some people have even reported decreased symptoms for even a year.
When Can I Repeat A Hydrocortisone Injection?
This depends on the joints being treated. However, you can get a steroid injection injected directly in the same area (joint) up to 4 times in the same year. Your healthcare professional decides the number of injections based on the extent of your joint symptoms (swelling, pain, and immobility).
Precautions For Patients Undergoing Repeated Injections
Steroid treatment can seriously affect your immune system, making you prone to common infections. Overuse of steroids (injections) makes it hard for a healthcare professional to treat even infections of general practice.
Infections like measles, COVID-19, and chickenpox can make you sick. So, informing your healthcare professional about any symptoms is very important.
Patients on long-term steroids must carry a steroid card. A steroid card or steroid emergency card is provided to you by your health professional/doctor.
Are There Any Contra-indications For Steroid Use?
Individuals having allergies to hydrocortisone or other medicines (local anaesthetic) can not receive steroids. Steroids can interfere with your blood pressure and blood sugar levels; therefore, hypertensives (people having high blood pressure) and diabetics (with poor blood sugar control) are poor candidates for steroid injections.
Your health professional will not treat your symptoms with an injection of steroids if you recently had an infection (measles, chickenpox, and shingles) or vaccinations.
How To Care For Your Knee Joint After A Steroid Injection?
Injection administration is a quick procedure, but you need to rest for a few days for proper healing. Stay in bed for a few hours after the injection, and avoid lifting weights/heavy items for a few days. Protect the injured area for a couple of days.
Cold application is an effective way to prevent post-operative complications. You can apply ice to the injection site. This also helps lower the pain. Avoid using bathtubs and hot tubs for a couple of days. Carefully monitor the knee joint for signs of infection (redness, pain, and swelling).
Risks And Side Effects Of Corticosteroid Injections
Side effects from these injections are rare and are only limited to the site of injection. High doses of steroid injections can hurt your adrenal glands. Patients undergoing repeated injections usually have underperforming adrenal glands, leading to fatigue, appetite issues, and weight loss. There is also an increased risk of infection.
Other Treatment Options For Knee Pain And Inflammation
Hyaluronic Acid And PRP
Other treatments for joint discomfort and pain involve injections of different medicines. The most commonly used medicines include hyaluronic acid and platelet-rich plasma (PRP). Hyaluronic acid injections are used to treat lack of lubrication in knee arthritis patients, while an injection of PRP enhances tissue regeneration in osteoarthritis.
Arthrocentesis
In addition to injections, other treatments aim to reduce inflammation physically. Arthrocentesis is a procedure in which excessive joint fluid is removed (via a needle) to reduce pain and swelling.
FAQs
- Can I Walk After A Steroid Injection In My Knee?You can carry out routine activities like walking after an injection, but your doctor won’t allow high-level activities for a couple of days (46 hours). Weight lifting or strenuous activity immediately after a steroid injection can lead to pain and fluid accumulation.
- Do I Need To Rest After Steroid Injection In Knee?Your doctor will advise you to rest the affected joint for a good 24 hours. Resting is crucial in reducing inflammation and allowing the injection to show its effects.
- How Successful Are Steroid Injections In The Knee?Steroid injections are very effective and efficacious in managing chronic pain in joints. Studies show that even a single steroid injection can alleviate pain and inflammation.
- Is A Steroid Injection In The Knee Painful?When given for pain, the steroid injection is mixed with a local anaesthetic. The discomfort from a steroid injection is only mild. You can experience a period of increased pain (steroid flare up) after the injection, but that goes away after 48 hours.
- What Should I Avoid After Knee Injections?You should follow these instructions after steroid injection in the knee joint:
Rest from work and avoid any hectic or weight-bearing activity for at least 48 hours. During this period, keep looking for signs of infection of the joint, i.e., redness, swelling, and tenderness. Apply ice on the affected joint to speed up the process of healing.