The treatment involves injecting a corticosteroid medication directly into the knee joint to reduce pain and inflammation. Relief can last from a few weeks to several months, depending on the severity of the condition. It's often used in combination with other treatments like physiotherapy for optimal results.
The injection itself can cause mild pain, and there may be a temporary increase in pain (steroid flare) after the injection. However, most patients tolerate the procedure well.
Corticosteroid injections are effective for temporary pain relief but do not address the root cause of the condition. They work best when combined with other treatments to manage symptoms and improve function.
When addressing knee pain, especially from conditions like osteoarthritis, Dr Khoo always presents corticosteroid injections as just one part of a multi-faceted treatment approach. There are several effective alternatives, both non-injection therapies and other types of injections, that are often used before, in combination with, or after cortisone shots. The fundamental treatments that should always be prioritised for knee pain involve physical therapy, which includes targeted exercises to strengthen the muscles supporting the knee, and weight loss, where applicable. Reducing weight significantly lessens the load and strain on the joint surfaces, which is one of the most powerful things a patient can do to relieve pain naturally. Simple medications like paracetamol or non-steroidal anti-inflammatory drugs, often applied topically as gels, can also provide effective daily management. For injection alternatives, there is viscosupplementation, commonly referred to as hyaluronic acid or "gel" injections. This involves injecting a gel-like substance into the knee to supplement the joint's natural lubricating fluid, which may help improve cushioning and joint movement. Unlike corticosteroids, which focus purely on inflammation, hyaluronic acid injections aim to improve the biomechanics of the joint. These may take longer to provide relief than cortisone, but the benefit, when achieved, can often last for six months or more. Another alternative is the use of orthobiologics, such as Platelet-Rich Plasma therapy. This involves taking a small sample of the patient's own blood, processing it to concentrate the healing growth factors, and injecting this plasma back into the knee. This therapy is aimed at stimulating the body's natural healing and anti-inflammatory response to the damaged tissue, offering a different pathway to pain reduction. Dr Khoo discusses these options on an individual basis, ensuring any suggested therapy aligns with the patient’s overall health goals and the severity of their knee condition.
Yes, like any medical procedure, corticosteroid injections are associated with potential side effects, although the majority of patients tolerate the procedure very well. Dr Khoo's team always ensures a thorough discussion of these risks before the procedure. The most common side effect is a temporary increase in pain at the injection site once the local anaesthetic wears off, often referred to as a 'steroid flare'. This is caused by the steroid crystals irritating the joint lining and typically lasts for one to two days. Applying ice packs is usually very effective in managing this discomfort. Other localised effects can include temporary flushing or redness of the face, or, rarely, a small area of skin thinning or colour change at the injection site. More serious, though extremely rare, side effects include infection within the joint, which would be marked by severe pain, swelling, and fever, and would require immediate medical attention. For patients with diabetes, the steroid can cause a temporary elevation in blood sugar levels for a few days, so monitoring is essential. As discussed previously regarding the frequency of injections, repeated and excessive use of cortisone in the same joint carries the long-term risk of potential damage or degradation to the articular cartilage, which is why we strictly limit the number of injections per year.
That is a very sensible question, and it is an important one for patient safety. Generally speaking, Dr Khoo strongly advises patients not to drive immediately after receiving a corticosteroid injection in the knee. The main reason for this advice is the local anaesthetic that is mixed with the steroid. This anaesthetic works instantly to numb the area, but because it affects the nerves, it can temporarily alter the sensation, strength, and proprioception—your body's ability to sense its position—in your leg. Since the knee is essential for operating the brake and accelerator pedals safely, this temporary numbness creates a significant driving risk. For this reason, patients must arrange for someone else to drive them home from the appointment. The effect of the anaesthetic is usually short-lived, typically wearing off within a few hours. Once the numbness has fully disappeared and you feel you have your normal strength and reaction time back, driving can usually be resumed. Dr Khoo and his team will always discuss this specific instruction with you before the procedure to ensure you have a safe journey home.
Yes, injections can be repeated if your pain returns, but this decision must be made carefully and cautiously. If your initial corticosteroid injection provided good pain relief that lasted for a reasonable period, it suggests your condition responds well to the anti-inflammatory medication, and a repeat injection is a valid option when the pain returns. However, Dr Khoo always adheres to strict safety guidelines to protect the long-term health of your knee. The most critical rule is maintaining a minimum waiting period of at least three months between injections into the same joint. We also generally limit the number of injections into any single knee to a maximum of three or four within one year. This limitation is essential because excessive or too frequent use of corticosteroids may increase the risk of damage to the articular cartilage. If you find the relief is becoming shorter each time, or if the pain returns quickly, it indicates that the underlying joint disease is progressing. In that scenario, repeating the injection may not be the best course of action. It's a sign that we need to stop relying on temporary solutions and focus on exploring more definitive management options, which could include further physiotherapy or a discussion about surgical solutions.
The duration of pain relief following a corticosteroid injection in the knee is highly variable, but for most patients, the relief is considered a temporary solution. While the local anaesthetic mixed with the steroid provides an immediate numbing effect that lasts a few hours, the anti-inflammatory action of the steroid typically takes about three to seven days to fully take effect. Once the steroid begins working, the period of meaningful pain reduction usually lasts anywhere from six weeks to three months. Some individuals with less severe inflammation may experience longer relief, occasionally up to six months, while others with advanced joint degeneration may find the benefits are shorter. It is important to understand that the goal of the injection is not to cure the condition, but to reduce pain and inflammation temporarily. This provides a crucial window of opportunity for the patient to engage effectively in other therapeutic measures, such as physiotherapy, strengthening exercises, or weight management, which are essential for long-term joint health and stability. The eventual return of pain indicates that the underlying joint issue, such as arthritis, is continuing its natural progression.
Based on established clinical guidelines and Dr Khoo's commitment to patient safety and long-term joint health, it is generally recommended to limit corticosteroid injections to a maximum of three to four injections in the same knee joint within any 12-month period. This limit is not a rigid rule, but rather a cautious principle followed by orthopaedic specialists to minimise potential complications. The reason for this careful approach is the concern that repeated steroid use in the joint may be associated with detrimental effects on the delicate cartilage and surrounding tendons. While a cortisone shot is highly effective for short-term pain relief and reducing inflammation, it does not cure the underlying condition, such as osteoarthritis. Therefore, we ensure a minimum interval of about three months between injections to give the joint time to recover and to prevent the build-up of the medication. If a patient finds that the relief from each subsequent injection is diminishing or wearing off quickly, it usually suggests that the disease process is advancing. At that stage, Dr Khoo would not recommend continuing with repeated injections, as the potential risk to the joint may start to outweigh the fleeting benefits. Instead, this signals the need to review other comprehensive management options, including physiotherapy, weight management, or, if appropriate, a discussion about surgical solutions like knee replacement. The focus is always on individualised treatment that achieves the best long-term outcome.
In line with best orthopaedic practice and to protect the long-term health of your knee joint, Dr Khoo recommends a cautious and conservative approach to the frequency of corticosteroid injections. The standard guideline is to limit injections into the same knee joint to no more than three or four times within any 12-month period. Crucially, there should be a minimum waiting period of approximately three months between each injection. This careful scheduling is necessary because while cortisone is excellent at reducing short-term inflammation, repeated or too frequent administration into the joint is associated with potential risks. These risks include the possibility of accelerating the loss of cartilage, which is the cushioning material in your joint, or weakening the surrounding soft tissues and tendons. The primary goal of the injection is to offer a period of significant pain relief that allows you to engage in physical therapy and modify activities. If the pain relief is not lasting for at least three months, or if you find the benefit diminishing with subsequent injections, it signals that the underlying condition is progressing. In such cases, Dr Khoo would recommend discontinuing the injections and exploring alternative, more definitive treatments, such as a detailed discussion about the potential for a surgical solution like a knee replacement.
That is a common question, as patients are understandably keen to know when they can expect relief. The experience of pain relief from a corticosteroid injection occurs in two phases, due to the two types of medication that are administered together. Immediately after the injection, you will feel a rapid and significant decrease in pain. This immediate relief comes from the local anaesthetic that is mixed with the steroid. This powerful numbing agent works within minutes to provide comfort, but its effect is short-lived, typically wearing off within a few hours. After the anaesthetic wears off, it is common to experience a temporary return of pain, and sometimes a slight increase known as a 'steroid flare' for up to 48 hours. This is normal and manageable with ice and simple pain relief. The true, sustained pain relief from the corticosteroid itself takes longer. As the steroid begins to reduce the inflammation inside the joint, patients usually start to feel a genuine, steady improvement in their symptoms anywhere between three to seven days after the procedure. The maximum benefit is often realised one to two weeks after the injection.