Three questions to ask before getting a knee injection

This isn't a post telling you not to get injections. It's a post giving you questions to ask at any clinic

Key points in 30 seconds

1. There's no such thing as "a knee injection." Hyaluronic acid injections (often called "cartilage shots" in Korea), steroid injections (often called "bone shots") and others differ in evidence, schedule and precautions depending on the name. Start by knowing the name of the injection you're getting.
2. Results for hyaluronic acid injections are mixed. In an analysis pooling 24 high-quality trials (8,997 people), the improvement in pain fell short of the threshold considered meaningful, and the risk of serious side effects was nearly 1.5 times higher than with sham injections.
3. Steroid injections can reduce pain in the short term, but in a trial of injections every 3 months for 2 years, pain was no different from sham injections, and cartilage loss was greater.
4. So the question to ask is "does this repetition have a set end?" Up to how many times, what improvement counts as success, and what comes next if it doesn't work.
5. The best use of an injection is to lower pain and open a window in which you can exercise. Check whether an exercise prescription is going along with the injections.

What we often hear

• "Every time I go, they tell me to get a shot before I leave, so I do."
• "It gets a bit better after the shot, then a few months later it hurts again."
• "What kind of shot? Just a knee shot."
• "I don't know how long I'm supposed to keep getting these."

When we ask in the clinic, "What injection did you get?", more than half answer, "Just a knee shot."

Let's be clear first. This isn't a post telling you not to get injections. There are cases where injections do their job in managing pain. Like the post on questions to ask about stenosis surgery, it's a post giving you questions to ask at any clinic. Three questions are enough.

First question: "What's the name of the injection I'm getting?"

There's the hyaluronic acid injection, commonly called a "cartilage shot," the steroid injection, commonly called a "bone shot," and several other kinds.

Different names mean different evidence, different intervals and different precautions. Knowing the name of what goes into your body is the starting point for every other question.

If you don't know the names and number of injections you've had so far, ask about that first at your next visit.

Second question: "Until when, and up to how many times, is the plan?"

Once you know the name, it's time to look at the evidence for that injection.

Results for hyaluronic acid injections are mixed. Some analyses support their effect. But in the strictest analysis, pooling 24 high-quality trials and 8,997 people, the improvement in pain fell short of the threshold patients feel as meaningful, and the risk of serious side effects was nearly 1.5 times higher than with sham injections. For a treatment with results this divided, at the very least how many times you'll try it before judging the effect should be set.

Steroid injections may work for pain in the short term. The problem is repetition. In a double-blind trial comparing injections every 3 months for 2 years with sham injections, there was no difference in pain after 2 years, and cartilage loss was greater on the steroid side. It can be used to put out a fire in an urgent moment, but there's no evidence for repeating it regularly with no end in sight.

The evidence for both injections points to one question: does this repetition have a set end?

"Come back when it hurts" isn't a plan. Ask how many times you'll get it, what improvement counts as success, and what comes next if it doesn't work. A good doctor welcomes these questions.

Third question: "Have I been prescribed exercise along with the injection?"

This may be the most important question.

What major clinical guidelines name as the first treatment for knee arthritis isn't injections but exercise. The evidence is written up in the knee arthritis evidence post.

The best way to use an injection is to lower pain and open a window in which you can exercise. If you don't fill that window with exercise, you'll find yourself looking for another injection every time it closes.

The problem isn't the injection itself, but a setup where only injections are repeated. If you're getting injections, check whether a prescription to build your thigh strength is going along with them. Where to start is written as a "do it like this" list in the knee walking post.

We're not competing with injections

Whether or not you're getting injections, what we do is the same.

First, we sort out whether it really is wear-and-tear arthritis. If the knee is swollen and hot, hurts even at night, suddenly locks, or started after an injury, we check the joint first in partnership with the radiology clinic on the 2nd floor of the same building.

Second, we measure the load. We look at leg alignment with an X-body posture analysis, and at weight and muscle mass with an InBody test.

Third, we make a knee that can exercise. We manage pain with acupuncture and pharmacopuncture (herbal acupuncture). For acupuncture, there's both a large pooled analysis that confirmed an effect and a large trial that found none, so we tell you both sides as they are and use it in a role that makes exercise possible.

Fourth, we prescribe exercise and check on it. We set thigh-strengthening exercises down to the method and number of reps, and check at your follow-up visit. We track progress with your pain score and how long you can walk without resting.

What changes

Not a calendar marked with your next injection date, but a calendar filling up with a record of walking times that keep getting longer.

That's what we're aiming for.

The path differs from person to person depending on the state of the knee, leg alignment, weight and strength.

Today's takeaway

Before getting an injection, ask three things. What it's called, how many times and until when, and whether exercise goes along with it.

Today, write down as much as you know about the names and number of injections you've had so far. If you don't know, it's fine to write "don't know." It becomes the starting point for planning what's next, at any clinic.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.

References

1. Pereira TV et al. Intra-articular hyaluronic acid injections for knee osteoarthritis: systematic review and meta-analysis (24 large high-quality trials, 8,997 people). BMJ. 2022;378:e069722.
2. McAlindon TE et al. Randomized double-blind trial of intra-articular triamcinolone injections every 3 months for 2 years (140 people). JAMA. 2017;317(19):1967-1975.

If you'd like to see the original papers, we can show them to you at your visit.