Episode 85 – Steroid Injections For Your Knee

Steroid Injections For Your Knee – And Why Stem Cell, PRP, or Prolotherapy are better

Knee steroid injections | Stem Cell PRP prolotherapy are better

Show Notes

  • Intro: Many doctors are hippocrites. Why? Because they need studies to prove something works. 
  • An example of this is steroid injections for the knee. 
  • We do Stem cell, PRP, or prolotherapy for this issues but many of my colleagues will do steroid injections. 
  • How do Steroids work? [2]
    • Suppress, or completely prevent, the full inflammatory reaction whether it is due to infectious, physical, or immunologic reasons.
    • Reduces early inflammatory events such as edema, cellular exudation, fibrin deposition, capillary dilatation, leukocyte migration, and phagocytic activity. 
    • Inhibits later events, such as capillary and fibroblast proliferation, deposition of collagen, and scarring.
    • We don’t completely understand their full mechanism

Plus, there are definite risks.

  • Tissues don’t heal: One medical paper stated “All glucocorticosteroids inhibit growth, regeneration and repair of cellular or intercellular components of dermal connective tissues, when penetrated through the skin barrier. The resulting atrophy is a logical manifestation of the action of these compounds.” [1]  That means that these medications (steroids) destroy tissue. Tissues simply can’t heal completely in the presence of steroids.
  • Risk of infection
  • immune suppression
  • Tissue damage
  • Increased appetite, weight gain
  • Sudden mood swings
  • Muscle weakness
  • Blurred vision
  • Increased growth of body hair
  • Easy bruising
  • Swollen, “puffy” face
  • Acne
  • Osteoporosis (bone weakening disease)
  • Worsening of diabetes
  • High blood pressure
  • Stomach irritation
  • Nervousness, restlessness
  • Having difficulty sleeping
  • Cataracts or glaucoma
  • Water retention, swelling
  • Tendon rupture
  • Subcutaneous atrophy

This is the basis, or foundation, for using steroid injections for knee pain. The idea is to reduce the swelling and improve pain. So there must be good ‘evidence’ that these injections work, right?

WRONG!!

A study published in JAMA recently evaluated saline injections versus triamcinolone injections for knee Osteoarthritis. The patients either received kenalog (triamcinolone) 40mg or saline injections every 3 months. They discovered that there was no difference in knee pain and the joints of the steroid patients actually got worse. 

Among patients with symptomatic knee OA, two years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain. These findings do not support [steroid shots] for patients with symptomatic knee OA.” [3]

WHY are we doing these shots?!?

  •  
  • Insurance pays for it
  • We think it works (but it doesn’t!!)

Now the thing that irritates me is that many of the physicians doing steroid shots are the same ones that won’t do something like prolotherapy because “there is not evidence it works.” And this is why they are hypocrites. 

References:

  1. Asboe-Hansen G. Influence of corticosteroids on connective tissue. Dermatologica. 1976;152 Suppl 1:127-32.
  2. McKay L, Cidlowski J. Physiologic and Pharmacologic Effects of Corticosteroids. Holland-Frei Cancer Medicine. 6th edition.
  3. McAlindon T, LaValley M, Harvey, W, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis. JAMA. 2017;317(19):1967-1975. doi:10.1001/jama.2017.5283
  4. Salinas J. Corticosteroid Injections of Joints and Soft Tissues. Medscape. Updated: Feb 10, 2017.