Cortisone - best to have them on a schedule or when needed?

[KenUSA36]

Hi everyone,

Had my first cortisone shot ever on my bad knee back in early-January. It's starting to get a little achier now. I'm torn on whether I just get another now to stay ahead of the curve or wait until I really need it.

Is there any science behind each cortisone shot being less effective simply due to too many shots? Or, is that based on the fact your knee just keeps getting worse? I only know that they want to do them no less than 3 months apart.

Thanks!

 

[SusieShoes]

I had cortisone shots into both knees for many years. They became progressively less effective. In the end, they didn't help even for a week. My knee doctor (not a surgeon) for all those years told me the cortisone no longer "worked" because my knees were too inflamed. Cortisone reduces inflammation but my knees, especially my left, were so bad just bending (not even walking or doing anything physical) inflamed the knee badly. Reduced inflammation at that point didn't get rid of enough inflammation to afford relief. My knees were unsalvageable.

Good reason to get knee replacements, right?

The main reasons for spacing out the shots, according to my doctor, were that injecting into the knee was something to do sparingly, along with being careful about cortisone's many side effects. Cortisone injections elevate blood sugar, for example, which can be a problem for pre-diabetic or diabetic patients and isn't necessarily great for anyone.

 

[KenUSA36]

Thanks as always Susie! Not sure if I have a lot of swelling. Do you think it’s best to wait then? Not diabetic or pre, and it’s been almost 5 months.

On another note, ever heard of Mobic or Meloxicam? Have a prescription for it. I was told it's a lot gentler on your stomach than Motrin or Aleve. It works decently but not as good as say 2 Aleve.

 

[SusieShoes]

Do you think it’s best to wait then?

Do you mean wait for TKR? That's a tough call only you can make. If you get another cortisone shot, that locks you into waiting another three to four months (or six if your surgeon is so inclined) before you can have a TKR. It comes down to how strongly you feel about buying yourself more time. I can absolutely guarantee that the time will come where you say "No more" and just schedule the surgery.

One factor to consider is whether buying time also means buying a worse pre-surgical knee, which could mean a more difficult surgery and recovery. That's something to talk over with your surgeon. I waited too long to have the surgery. My left knee was a crumbling mess with bone spurs that were shredding soft tissue. (No wonder the cortisone wasn't working!) When I had both knees replaced, my right knee recovered quickly and beautifully. My left... not so much. It was painful for much longer (nine months vs. three) and still has slightly less bend. It twinges on certain movements still. Don't get me wrong: It's a very successful knee! I just wish I had gotten to it sooner.

On another note, ever heard of Mobic or Meloxicam?

I've heard of this drug but am neither a nurse nor have used it. Many people on the forum speak well of it, though!

 

[Mutti3]

I had cortisone injections in my knee as need every 4-5 months for 3 years. It worked less with each injection until the it was not effective. Waited a year after my last injection because I was waiting for the “stars to align “in my life. No other reason. I used that time to get myself in the best possible physical shape could manage. I did upper body weights, yoga, and attended a gym. I used those drugs you mentioned everyone is different, didn’t work for me.

 

[KenUSA36]

Hi Susie I meant wait for the cortisone. I may just be overthinking it. I'm not quite ready for a tkr since I have more okay or good days than bad, and I still have joint separation. Although my lateral side is going downhill fast, and there's no way I'm breaking my femur for an osteotomy.

Mutti thanks for the reply!

 

[Jockette]

I took Meloxicam and found it did bother my stomach even though I was told it wouldn’t. We are all different and react to things differently.

 

[Celle]

Mobic is another name for Meloxicam, which is an NSAID (non-steroidal anti-inflammatory drug).
Even though your doctor said it could be gentler on your stomach, it still carries the dangers of other NSAIDS - gastric bleeding and this:
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study
Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers

Never take it on an empty stomach and stop taking it at once if you experience any gastric symptoms, such as pain or indigestion. Don't rely on NSAIDs long-term.

 

[SusieShoes]

Ah... wait for the cortisone. When it comes to that, your best bet is to heed the advice of your doctor. That's what I did. Find the best orthopedic doctor or surgeon you can recruit and then allow them to guide you. I know what you mean about not being ready yet. I held off my knees for 10 years. My ortho guy always told me I would know when it was time for TKR. He was dead right about that. When you're ready, you'll know!

 

[Casuals]

Your right! You will know, when you're ready. Cortisone for me was awesome the first time. Second and third not a so much! I have waited till I am using a walker and can barely do anything. Sweeping and/or mopping put me down. But I never wanted surgery! I am a huge baby. I almost just said to heck with it all. But pulled myself up and called the surgeon to let him know, I was ready. I have no choice now, give up and sit here use a wheelchair I'm sure, Or stop being a baby, get and this done! I need both knees done, but it seems like they are only doing one at a time! Only met the surgeon that one time!

 

[Mumu]

My first round of cortisone gave me relief for 3-4 years! Second round about a year. Third round only 3 months which is when i scheduled surgery.

 

[yesyvonne]

I did cortisone in each knee approximately every 4 to 6 months for many years. I asked for it when the pain level told me I needed it. Was the miracle cure for me for a long time.

But then I had a painful time of it walking around cities in Spain and Portugal in fall 2016 even with cortisone right before the trip; came home and got more cortisone around Nov 2016 that got me through that winter. Probably should have done the surgery then instead, but I was a baby and scared about it, so continued on without.

When I planned a trip to Warsaw, Krakow, and Prague in June 2017, a year ago, I waited with the next round of cortisone, even though my knees were hurting, getting it right before departure, in May. And boo hoo that's when I found out it did nothing by that point and I had an extremely painful time of it, walking those cities. Big mistake.

Came home and immediately reported that agony; was invited to come in for yet another round of cortisone, only about a month after the May shots, late June 2017. And that round of shots did nothing either. So then I was offered and accepted Synvisc, three weekly shots in both knees and that did nothing either. Still in great pain. That's when I was convinced I was going to have to get a grip and schedule the surgery. Except then I had an unexpected adventure with pulmonary embolisms in July 2017 that put me in ICU for three days and then on anticoagulant for six months, and so surgery was not allowed until that was all cleared up. Which it was, in early 2018, and I got my hematologist's okay to go ahead with my first TKR, which happened in March this year. And while it wasn't easy, it wasn't as bad as I feared it would be.

If there's a lesson to be learned, I suppose it's don't wait too long, as I did, living in agony before you go ahead with the joint replacement surgery! In hindsight I probably should have had my surgery in winter or spring 2016/2017, or even before the fall 2016 trip, and instead it didn't happen until March 2018. Because I was scared.

I have heard that relying on cortisone injections can actually hasten the degeneration of the joint. But I did it anyway because I was so frightened of having the surgery.

 

[KenUSA36]

@Mumu so great you got a few years out of it!

@yesyvonne Sorry to hear your European trip was ruined. I recently did Ireland, and it was tough to forget about my knee. I managed, but it always felt like my bad knee. I'm only looking at my 2nd injection ever, and it sounds like they're happy if they're more than 3 months apart. It's great to hear your TKR wasn't as bad as you thought. I keep dreading going through it, but I need to keep telling myself I won't be bed bound. I keep imagining my ACL tear experience 16 years ago where I couldn't use my left leg for over a month. That's depression city when you are living your life on crutches for 6+ weeks.

 

[yesyvonne]

@KenUSA36 "Sorry to hear your European trip was ruined." Well, I wouldn't say that, exactly, as I'm still glad I got to see those places, and I have lots of great photos and memories -- but yeah, would have preferred to skip the agony. If I'd been brave enough to have the surgery earlier, it would have been way more positive an experience!

No, you will NOT be bed bound, almost certainly. You can move around home post-op, and the PT will be getting you up and at it pretty quickly. Plus your bio says you are only 36! You will heal faster than us older folks, I imagine.

Prior to surgery, I counted 150 steps from the closest parking spot to my apartment's front door and so I did that amount of walking in the hospital with a walker prior to discharge and then when I got out of the car when I came home, too. No crutches at all. Only used the walker for a few days, then transitioned to a cane. Ditched that after a couple weeks except for when I had to get up in the night, then used it for a few more weeks for security, fearful of falling half-awake. By the time I was in outpatient PT, which started three weeks post-op, I was driving and walking independently.

 

[Josephine]

Is there any science behind each cortisone shot being less effective simply due to too many shots? Or, is that based on the fact your knee just keeps getting worse?

It's that your knee is getting worse!

I only know that they want to do them no less than 3 months apart.

That's the general rule. Read this Cortisone shots: are they safe and is there a limit to how many?


I actually had barely any ongoing pain, just what I refer to as a 'stone in the shoe' pain which came and went erratically. Sometimes it lasted for an hour, sometimes for a week but I knew what caused it so let me share that with you.

Arthritis has the effect of making our joints crumble like an old concrete step.

It breaks down, creating lots of grit and debris. Generally this stays in the pouches at the side of the joint but every so often, a just one little bit gets into the weight bearing part of the joint,into the 'sweet spot', and then we get that extreme pain and can't bear weight on the leg at all! Pain killers do nothing, nor do things like braces. We are just conscious of this horrible burning pain that all of a sudden goes away!

It's every bit as disabling as the constant bone-on-bone pain so many others suffer and is a very good indicator that a joint replacement is needed.

To assess your need for replacement, print off the form in this link, read the instructions and fill it in
Score chart: how bad is my arthritic hip/knee

 

[KenUSA36]

@Josephine Thanks! I have ongoing degenerative tears on the wayyyy outside of my knee (like 9'oclock right not he edge). It's a bummer. Comes and go, feels like I'm rubbing a cut.

8 years ago I had one of those nice button horn tears (I think) where the meniscus can actually fold over and get in the knee joint. Ouch! Couldn't stand. I'd have to lay on my side and push on my knee to try and get it to unfold. What a mess. Had to get it removed. But, at this point I'm not doing any more meniscus surgery. I'm like at 50-60% MAYBE, so I don't want anymore removed. I'll deal with the ouchie until it gets super bad.

 

[Josephine]

8 years ago I had one of those nice button horn tears (I think) where the meniscus can actually fold over and get in the knee joint.

You mean a bucket handle tear?

 

[KenUSA36]

Yes haha. Should have googled that first.

 

[ApricotPie]

I just had what I hope is my 3rd and last cortisone injection in my right knee. It will get me through some Spring travel and family events. Then about two months of waiting to hit the four month mark, then the TKR.


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