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However, a randomized, placebo-controlled, double-blind study by McAlindon et al found that in patients with knee osteoarthritis, intra-articular corticosteroid injections (40 mg of triamcinolone acetonide, administered quarterly over 2 years) led to an increase in cartilage loss and was associated with less pain reduction than placebo injections. The study determined that the mean change in index compartment cartilage thickness in the corticosteroid patients was about twice that of the placebo subjects. (The investigators stated, though, that due to the timing of pain measurements, the study could have missed transient pain reductions in the corticosteroid group.) [ 18 , 19 ]
This is a very safe procedure with few significant risks. Few patients complain of side effects but occasionally problems are experienced. The commonest complaint is a temporary aggravation of the symptoms over one, two, or even three days. Very rarely patients get general symptoms related to absorption of the corticosteroid into the circulation. This generally only occurs either when larger doses are used or in some patients who are more sensitive to corticosteroids. In diabetics this absorption can increase the blood sugar levels –which should generally be checked several hours after the is a risk of local damage to the soft tissues at the injection site. Tissue atrophy (a thinning or weakening) of the skin or subcutaneous fat (found just beneath the skin) rarely occurs when the injected material is very close to the surface. Tissue atrophy can also involve deeper structures. It is more likely with repeated injections at the same location. Some patients find that the injection gives them pain relief for a few months, but then the pain comes back and they wonder about the safety of having another injection. Although the exact risk of multiple injections is not known, most doctors would advise against injection more than 3-4 times a year to avoid tissue atrophy. This is more important when the injection is being done in areas in which there is already significant wear or tear (torn tendons or ligaments). extremely rarely people are allergic to the injected medication (as with any drug). The exact risk of this is not known. There is a risk of infection, which is very small and probably lies between 1 in 20,000 and 1 in 75,000 injections performed. The procedure should not be performed if there is broken skin or infection overlying the bursa, or if the bursa may already be infected. Recent studies show steroid injections should probably not be given within 3 months of a planned total joint replacement as there is a slightly higher risk of postoperative infection of the prosthesis.