Hip and Knee Injections for Osteoarthritis: The Side Effects

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If you have osteoarthritis and are considering having a hip injection, there are some side effects to consider beforehand.

Minor Side Effects

These can be pain at the injection site, post-injection cortisone "flare" (this is when the steroid makes the pain worse instead of better), facial flushing, atrophying of fat and joint infection. In black patients there may be loss of skin pigmentation at the site of the injection.

Sometimes the injection may not relieve pain and your doctor will not know if the injection will be beneficial to you until after it is done. If you are diabetic, it may cause hyperglycemia.

Moderate and Severe Side Effects

Septic arthritis (this occurs in rates of one per 3,000 to one per 5,000 injections), osteonecrosis (bone death), and an increased risk of infection after a total hip replacement operation, suppression of the pituitary and adrenal glands, decrease in bone formation, osteoporosis, joint tissue damage, mood swings, insomnia, depression and personality changes.

Death has occurred after intra-articular steroid injection, due to anaphylactic shock.

Acceleration of Joint Degeneration

Having a hip injection may accelerate the joint degeneration in the long-term. This is because inflammation is part of the immune system response and occurs when the body’s defense cells leave the blood and enter the tissue around the injured site in an attempt to heal it.

If this process is stopped, then the body’s attempt at healing itself is stopped which may result in speeding up of the osteoarthritis. However, prolonged inflammation can be harmful.

System Absorption and Immune System Depression

Intra-articular joint injections are localized to the affected joint so any immune suppressant effect should occur only in that joint. However, it is possible that system absorption may occur in rare cases, so that the effect of the steroid is throughout the body. This has led patients to be misdiagnosed with endocrine disorders they did not have. If this happens, the person will be immune-compromised. (5)

The patient information leaflet for one brand of intra-articular steroid injection says that it can increase susceptibility to infection and increase the severity of infections. (1)

The presentation of such infections may be altered and reach an advanced stage before they are recognised. Viruses such as chickenpox and measles, although minor illnesses, can be fatal in immune-suppressed people.

Contraindications (People who shouldn’t have a hip injection):

• Anyone who is hypersensitive to any ingredient in the injection (you can ask to see the patient information sheet beforehand)

• Anyone that has an infection

• Anyone who is pregnant – if you are, speak to your doctor. Animal studies have shown that steroids cause cleft lip and palate, but there is not enough evidence to say whether this occurs in humans.

• Anyone who is nursing a baby – the steroid can pass through breast milk and could suppress the growth of the baby.

Sources:

1. Adcortyl Intra-Articular/Intradermal Injection 10mg/ml, EMC Medicines. Web. 8 November 2011. http://www.medicines.org.uk/emc/medicine/6392#PRODUCTINFO

2. Articular Steroid Injections, Wheeless' Textbook of Orthopaedics. Web. 8 November 2011. http://www.wheelessonline.com/ortho/articular_steroid_injections

3. Intraarticular cortisone injection for osteoarthritis of the hip. Is it effective? Is it safe? Curr Rev Musculoskelet Med. 2008 December; 1(3-4): 227–233. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682414/

4. KENALOG-40 INJECTION, Bristol-Myers Squibb Company. Package Insert. Web. 8 November 2011.
http://packageinserts.bms.com/pi/pi_kenalog-40.pdf

5. Diagnosing the unrecognized systemic absorption of intra-articular and epidural steroid injections, Endocr Pract. 2009 Apr;15(3):225-8. http://www.ncbi.nlm.nih.gov/pubmed/19364690

Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting.

Reviewed November 9, 2011
by Michele Blacksberg RN
Edited by Jody Smith

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.