Corticosteroid injections are the most widely used injection for arthritis pain in the knee and hip. They deliver a potent anti-inflammatory medication directly into the joint, reducing swelling and pain at the source.
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Cortisone injections are not a cure for arthritis. They do not rebuild cartilage or reverse joint damage. What they do is reduce the inflammatory component of arthritis pain, which can provide meaningful relief lasting weeks to months. For many patients, this relief makes the difference between struggling through daily activities and living comfortably.
How Cortisone Injections Work
Arthritis pain is driven by two factors: mechanical damage (worn cartilage, bone-on-bone contact) and inflammation (the joint’s response to that damage, which causes swelling, warmth, and pain). Cortisone targets the inflammatory component.
The corticosteroid medication is injected directly into the joint space, where it reduces the production of inflammatory chemicals and decreases swelling. The result is less pain, less stiffness, and improved range of motion.
Because the medication is delivered locally rather than taken systemically, the dose needed is small and side effects are minimal compared to oral steroids.
What to Expect
01. The Procedure
Cortisone injections are performed in the office and take about five minutes. Dr. Zalikha cleans the skin, may apply a cold spray or local anesthetic, and injects the corticosteroid along with a small amount of lidocaine (for immediate, temporary numbing) into the joint using a standard needle.
For knee injections, the entry point is typically on the outer or inner side of the knee just below the kneecap. For hip injections, image guidance (fluoroscopy or ultrasound) may be used to ensure accurate placement in the deep hip joint.
02. After the Injection
- The lidocaine may provide temporary numbness for a few hours
- Some patients experience a mild flare (increased soreness) for one to two days after the injection. This is normal and resolves
- Meaningful relief typically develops within three to seven days
- Ice and rest for the remainder of injection day are recommended
- Normal activities can be resumed the next day
03. How Long Relief Lasts
Duration varies. Some patients experience relief for two to three months. Others benefit for six months or longer. Some get less than a month of benefit, particularly with advanced arthritis. The response often depends on the severity of the underlying disease.
If a cortisone injection provides no relief at all, it raises the question of whether the joint is truly the source of the pain, and further evaluation may be warranted.
How Often Cortisone Injections Can Be Given
Most guidelines recommend no more than three to four corticosteroid injections per joint per year. This limit exists for two reasons:
1. Diminishing returns: If the injection is needed every few weeks, it suggests the arthritis has progressed beyond what cortisone can effectively manage
2. Potential cartilage effects: Some research suggests that very frequent corticosteroid injections may accelerate cartilage loss, though the clinical significance of this finding is debated
Dr. Zalikha uses cortisone injections strategically. He does not put patients on an automatic schedule. Instead, injections are given when flares occur and when the expected benefit justifies the treatment.
When Cortisone Injections Are Most Useful
Cortisone injections work best for:
Acute flares of arthritis with significant swelling
Diagnostic purposes: If a cortisone injection into the joint relieves your pain, it confirms the joint is the source. If it does not help, the pain may be coming from somewhere else (spine, soft tissues, another joint)
Buying time: Patients who are not ready for surgery, are working on weight optimization, or have upcoming events or travel may use cortisone to bridge their symptoms
Pre-surgical timing: Some patients benefit from a cortisone injection before an important event, knowing that surgery will be scheduled later
Limitations and Considerations
Cortisone is a powerful tool, but it has limits:
It does not treat the underlying structural damage
Relief is temporary and may shorten with repeated use
It is not a substitute for a comprehensive treatment plan that includes physical therapy, weight management, and activity modification
In patients considering joint replacement, cortisone injections should ideally be spaced appropriately before surgery to minimize infection risk. Dr. Zalikha discusses timing if surgery is being planned
If cortisone injections are losing effectiveness, it may be time to consider other options, including hyaluronic acid, PRP, or knee replacement surgery. Dr. Zalikha helps patients navigate these decisions based on their individual situation.
Cortisone is one of several options for an arthritic joint. For how it compares with the alternatives, see our overview of knee injections. If joint replacement is already on your calendar, our pre-op checklist for joint replacement walks through injection timing alongside the rest of your preparation.
References
Habib G, Khazin F, Sakas F, Hakim G, Artul S. The impact of intra-articular injection of diprospan at the knee joint on blood glucose levels in diabetic patients. Eur J Rheumatol. 2018;5(2):96-99. PMID: 30185356.
Cancienne JM, Werner BC, Luetkemeyer LM, Browne JA. Does timing of previous intra-articular steroid injection affect the post-operative rate of infection in total knee arthroplasty? J Arthroplasty. 2015;30(11):1879-1882. PMID: 26071248.
American Academy of Orthopaedic Surgeons. Cortisone Shot (Steroid Injection). OrthoInfo, orthoinfo.aaos.org.
FAQ
Frequently Asked Questions
If you have diabetes, yes, temporarily. In a published study of diabetic patients who received a steroid injection at the knee, blood glucose rose significantly after the injection, with median levels peaking at 310 mg% at roughly 11.5 hours and a later peak seen around 45 hours after the shot [1]. The effect is transient, but it is real. If you are diabetic, check your glucose more often for the first day or two after an injection, and let the office know if your readings stay unusually high.
Published data associate recent injections with a higher infection risk after knee replacement. A national database study found that patients who had a knee injection within three months before total knee replacement had a significantly higher post-operative infection rate, 2.6% within three months of surgery, roughly twice the rate seen in patients without a recent injection, while injections given more than three months before surgery showed no significant increase [2]. That is why many surgeons space the last cortisone shot about three months out from a planned joint replacement. There is no single rule that fits every situation, though. Dr. Zalikha will tell you the timing for your case when surgery is being planned.
Relief is temporary by design. The American Academy of Orthopaedic Surgeons notes that a cortisone shot can last for several weeks, and the broader research literature generally reports relief lasting from a few weeks up to about three months [3]. Some patients do better than that, and some, particularly those with advanced bone-on-bone arthritis, get less. If a shot wears off quickly or does nothing at all, that is useful information in itself: it suggests the inflammation cortisone treats may no longer be the main driver of your pain.
There is no absolute number. Frequency is judged by your response and by the condition of the joint: how much relief each injection provides, how long that relief lasts, and whether the underlying arthritis is stable or progressing. When injections are needed more and more often, that pattern usually says more about the joint than about the medication, and it is usually the point at which it makes more sense to discuss other options than to simply schedule another shot.
Ready for answers about your hip or knee? Request an appointment with Dr. Zalikha.
