Radiologists must warn patients of potential safety risks associated with common joint treatment

Steroid injections commonly used to treat hip and knee pain may be more dangerous that experts previously thought.

Research led by Ali Guermazi, MD, PhD, found that corticosteroid injections may quicken progression to osteoarthritis, which eventually could lead to joint collapse. In light of their study published Oct. 15 in Radiology, Guermazi and colleagues suggest physicians incorporate such risks into patient consent forms.

"We've been telling patients that even if these injections don't relieve your pain, they're not going to hurt you," Guermazi, with Boston University School of Medicine, said in an RSNA news release. "But now we suspect that this is not necessarily the case."

Hip- and knee-associated osteoarthritis is common, often treated by injecting anti-inflammatory corticosteroids into the joint to reduce pain and swelling. Widely seen as safe, patient consent forms typically only mention rare side effects associated with needle-based procedures, the researchers explained.

Guermazi and co-authors reviewed adverse joint events seen in 459 patients with knee and hip osteoarthritis who received at least one intra-articular corticosteroid injection at a U.S. hospital in 2018. After review, the team identified four main findings: accelerated osteoarthritis progression with loss of the joint space, subchondral insufficiency fractures (stress fractures that occur beneath the cartilage), complications from osteonecrosis (death of bone tissue) and rapid joint destruction including bone loss.

To combat the problem, physicians should pay close attention to patients with mild or no osteoarthritis on x-rays who are referred for joint pain injections, particularly when pain doesn’t match imaging findings. Clinicians should also reconsider planned injections in patients with short-term changes in pain as underlying conditions may be at fault. Younger patients and those in early stages of the disease, the researchers noted, should be notified of the potential dangers of steroid injections.

"This information should be part of the consent when you inject patients with intra-articular corticosteroids,” the researchers wrote.

Richard Kjowski, MD, with the University of Wisconsin School of Medicine and Public Health’s Department of Radiology, explained in a related editorial that some might want to take the “small risk” of adverse events if it will reduce their pain, but they need to be informed.

“Patients have the right to make this decision for themselves, and this requires radiologists to discuss all potential risks and benefits with the patient when obtaining written informed consent,” Kjowski concluded.