Intra-Articular Corticosteroid Injections for Symptomatic Knee Osteoarthritis

What the Orthopaedic Provider Needs to Know

Cody L. Martin, MD; James A. Browne, MD


J Am Acad Orthop Surg. 2019;27(17):e758-e766. 

In This Article

Subsequent Injections

Little data are available to guide practitioners with respect to the frequency and total number of injections. A common recommendation is that no more than 3 to 4 steroid injections into a knee be performed within a year, although this seems to be based on professional opinion and various opinions exist.[5,9,11] The safe maximum number of lifetime knee steroid injections is also unknown. Long-term repetitive use of intra-articular steroid injections for management of symptomatic knee osteoarthritis has generally been found to be ineffective.[35] Patients can be counseled that the lifetime limit of knee steroid injections is a function of how long the treatment provides relief without adverse effects.

Liu et al[36] performed a longitudinal study of intra-articular injection use in patients with knee osteoarthritis. They found that over 9 years, approximately 59% of patients who received an initial corticosteroid injection in the knee did not receive additional injections, whereas approximately 18% of patients switched to hyaluronic acid injections. Therefore, subsequent steroid injections occurred only in a little over 20% of patients after receiving their first corticosteroid injection. The authors discussed how treatment switching versus continuation or discontinuation in patients with chronic disease may be related to suboptimal efficacy, safety concerns, or tolerability of the treatment.[36]