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Intra-articular injections are not as safe as we thought

Steroid injections in the hip and knee to treat osteoarthritis can harm the joints.

Corticosteroid injections used to treat hip osteoarthritis pain knee may be more dangerous than previously thought.

A recent study led by Ali Guermazi, from the Faculty of Medicine of the Boston University (United States), has found that injections of corticosteroids may be associated with complications that potentially accelerate destruction of the joint and may accelerate the need for total replacements of hip and knee.

Intra-articular injections

“We have been telling patients that even if these injections do not relieve their pain, they won’t hurt them”, admits Guermazi. “But now we suspect that this is not necessarily the case”

In a review of the existing literature on complications after this treatment, Guermazi and colleagues identified four main adverse findings:

  • Accelerated progression of osteoarthritis.
  • Loss of joint space
  • Subchondral insufficiency fractures (stress fractures that occur below the cartilage)
  • Complications of osteonecrosis (death of bone tissue)
  • Rapid destruction of the joints, including bone loss.

What do the experts recommend?

Researchers recommend careful screening of patients with mild or severe osteoarthritis. Void on radiographs that are referred for injections to treat joint pain, especially when pain is disproportionate to imaging findings.


“Intra-articular injection of steroids into the joints is a very common for osteoarthritis-related pain, but possible aggravation of pre-existing conditions or actual side effects in a subset of patients should be further explored to better understand the risks associated with it” -concludes Guermazi- “What we wanted to do with our work is tell the doctors and patients to be careful, because these injections are probably not as safe as we thought”

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