Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought?

Review written by Dr Alison Grimaldi info

Key Points

  1. Corticosteroids have been shown to be chondrotoxic (toxic to cartilage cells) and higher levels of local anaesthetic exposure have also been associated with chondrolysis (death of cartilage cells).
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BACKGROUND & OBJECTIVE

Intra-articular corticosteroid injection (IA-CSI), usually combined with a local anaesthetic, is commonly employed as first-line management for joint-related hip and knee pain. While adverse systemic effects of IA-CSI are rare, there are growing concerns regarding adverse joint effects.

From meta-analysis of basic science studies, corticosteroids have been shown to be chondrotoxic (toxic to cartilage cells), apparently due to impact on cartilage proteins (1). Furthermore, local anaesthetics in higher concentrations and longer exposures have also been associated with chondrolysis (death of cartilage cells), with cell death rates higher in osteoarthritic cartilage (2). One recent retrospective observational study of patients with hip osteoarthritis (OA) reported that 31 out of 70 (44%) who were treated with IA-CSI had progression of osteoarthritis within 10 months of injection, compared with only 17 out of 70 (24%) of the control patients with hip OA (3).

The authors of this study aimed to add to what is known by reporting adverse joint effects in the higher volume of patients passing through their institution.

There are growing concerns regarding adverse joint effects of intra-articular corticosteroid injection.
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Arguably, young athletes with no or early joint change are being referred too often for IA-CSI, in an effort to reduce time to return to sport.

METHODS

Data was collected on adverse joint events for a population of 459 patients who underwent IA-CSI with local anaesthetic into the knee or hip joint, for painful OA. As patients were receiving treatment in a hospital orthopedic outpatient clinic, most

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