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Cortisone shots: how many and how often?

Discussion in 'Knee Replacement Pre-Op Area' started by Agnes, Jun 10, 2017.

  1. Agnes

    Agnes Junior Member
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    I have had three so far, about a month between each one. The relief was great for ten days after the first, then less so for the other two. I'm not in agony, but I need time to sort out my knee when I first stand up, and I walk with a limp. Doctor seems to want to keep injecting steroid until I decide to go with the other kind. I'm planning to get a second opinion whenever I think I'm ready for another shot, but I gather the guy I'm seeing doesn't expect the steroid shots to last more than a couple of months. Wondering if this is typical.
     
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  2. Irish Joe

    Irish Joe Forum Advisor Staff Member Forum Advisor

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    I know of people for whom steroid shots have lasted many months.
    In my case it was not effective at all.
    I had a day procedure called Arthroscopy which has significantly improved my situation although sometimes they don't help much I understand. I think it all depends on how bad your knee is.
    Total knee replacement is often the final solution.
    Joe......
     
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  3. SusieShoes

    SusieShoes Forum Advisor Forum Advisor

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    When I first started with cortisone shots in my knees, the relief would last for about two to three months. And it was good relief, as if my knees were normal. When cortisone became less effective (weeks of relief instead of months and not complete relief even then) I started with Synvisc injections. At first the relief from those lasted six months or longer. But then those too stopped offering relief at all. And cortisone was good for at best a week. And that was when I knew I had to have the surgery for knee replacements.

    All told, the above took ten years. At first the cortisone was like a bit of heaven for months on end. At the end, it didn't do anything.
     
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  4. Miss Muffet

    Miss Muffet Forum Advisor Forum Advisor

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    Mine lasted a few months only. But it was some relief at least. I believe there is a limit as to how many you can have - that was what my surgeon said, because of the risk of introducing infection. As @Irish Joe says, THR is the solution. I've never looked back!
     
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  5. Irish Joe

    Irish Joe Forum Advisor Staff Member Forum Advisor

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    Agreed @Miss Muffet.
    Though total Hip replacement likely won't work for Knees.:snork:
    Joe.......
     
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  6. keefsmom

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    Got my last cortisone in both knees 3 mos before surgery; 3rd for replaced left knee, 5th for other. I still feel the effect of the cortisone on my non operative knee, which I'm grateful for during recovery. First shots I got lasted a good 6 months. Like @SusieShoes, I had synvisc injections too--twice. Did next to nothing for me, everyone is different though!
    All told I messed around with alternatives to surgery (and ingested an increasingly alarming amount of ibuprofen) for 6 years before getting the first of my knee replacements. It's hard to know when it's time, for me it took finding the right surgeon, and what really brought it home for me was taking the assessments available here on BoneSmart to show me how limited my life had become due to the pain. (I believe you can find them under the article tab.)
    I am still fewer than 3 weeks post surgery but I can tell you that the absence of arthritis pain in my replaced knee has me gobsmacked! One down, one to go!
     
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  7. JennyLynne

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    For me, cortisone was great for a couple weeks.
    I found great relief from Euflexxa injections- a series of 3 shots over 3 weeks. At first I got about 4 months of relief. Then less over time, and I decided to have a TKR.


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  8. Miss Muffet

    Miss Muffet Forum Advisor Forum Advisor

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    Oh dear - pay attention Miss Muffet!
     
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  9. sooz58

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    I just went to my os about a month ago, we discussed shots, surgery and he told me, that when it came right down to it I have bone on bone both knees left a little worse than right. He told me yes he could give me shots, they works some of the time but not for as long as they are supposed to. He also said the shots would just be a band-aid. I wanted to be able to move and not let things get worse. So here a month later I am getting surgery Tuesday!
     
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  10. Agnes

    Agnes Junior Member
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    Thank you all for the replies. It sounds to me like it may depend on the doctor. My MRI indicates severe osteoarthritis and other abnormalities, but my doctor seems to think he can keep me going with shots until I'm closer to 70. I'm 64 now. My family doc thought I'd be getting a replacement in about a year. I think I'm going to wait to see if the bad pain returns like I had before the first shot. If/when it does, I will get a second opinion.
     
  11. Celle

    Celle Forum Advisor Staff Member Forum Advisor

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    The shots seem to work for most people for a while, but they seem to get less effective.

    Once you have severe damage, I can't see much point in waiting. Your knee will only continue to deteriorate and waiting too long can have a detrimental effect on your muscles and ligaments, making for more difficult surgery and recovery. I know, because I was persuaded to wait for 9 years. In that time, my muscles grew weak and my tendons distorted.

    I had my second knee replaced as soon as my surgeon said it was ready. I had a much easier recovery.

    Knee replacements can last for 30 years or more nowadays, so you don't have to wait until you are "old enough". If you wait, your knee will continue to deteriorate, having more and more impact on your quality of life. Why wait, when you can get it fixed and start living the life you want again?

    Another thing to think about: At the moment, your general health is good and you are in good shape for surgery. Who knows what it will be like when you are 70?
     
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  12. kayak59

    kayak59 Senior

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    I keep hearing "you can only get so many" when it comes to cortisone shots. I have lost count of how many I've had for my various arthritic joints, plus I've had shots for bad poison ivy. I also usually have to take multiple rounds of oral cortisone every summer because of poison ivy. I anticipate needing more cortisone shots for my spine in the upcoming years, and of course, for poison ivy. I don't know what I'd do if any of my doctors refuse to give me more. I know I'll have to stop if I get a reaction but I'll continue taking it until/if that happens.
     
  13. Pheebs52

    Pheebs52 Supremo

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    I think Celle makes an excellent point on the dangers of waiting too long for TKR. If your knee is already severe, bone-on-bone, it's not going to improve, only deteriorate. It may deteriorate quite rapidly; mine did. I chose to have it done now at 64 so I could enjoy attaining 65. At our age, 6 years down the road could bring all manner of other health problems that could possibly preclude you from having this surgery....don't want that, right? It's a huge decision and a challenging recovery, but that won't become easier with age.
     
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  14. Jamie

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    The length of time between cortisone injections can vary with doctors, but I know quite a few who will not give them more frequently than every 3 months. There is some evidence out there that the shots might weaken tendons and ligaments.

    Here is the guidance provided by the Mayo Clinic:

    Complications of cortisone shots can include:
    • Joint infection
    • Nerve damage
    • Thinning of skin and soft tissue around the injection site
    • Temporary flare of pain and inflammation in the joint
    • Tendon weakening or rupture
    • Thinning of nearby bone (osteoporosis)
    • Whitening or lightening of the skin around the injection site
    • Death of nearby bone (osteonecrosis)
    • Temporary increase in blood sugar
    Limits on the number of cortisone shots
    There's concern that repeated cortisone shots might cause the cartilage within a joint to deteriorate. So doctors typically limit the number of cortisone shots into a joint.

    In general, you shouldn't get cortisone injections more often than every six weeks and usually not more than three or four times a year.

    Celle is right about not waiting too long to get a TKR. My first knee was so much worse and the recovery was more difficult. I didn't wait as long for my second one and found everything went much easier. The surgeon has an easier time getting the job done when there's not as much damage and consequently your recovery can be easier.....less tissue manipulation = less surgical pain.
     
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  15. yesyvonne

    yesyvonne New Member

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    Helpful to see that list of potential downsides to cortisone shots, so thanks for that. I've been getting them in both knees for years now, trying to space them out as far apart as I can tolerate the pain without them. Both my doc in Ann Arbor before I moved, and my doc here in East Bay SF where I live now said shots no more than every 3-4 months and that they have the joint deterioration downside.

    Had a round of shots in early November, then put off next round until late May, just before a two-and-a-half week trip to Eastern Europe that I knew was going to involve lots of walking. Long story short was in agony much of the time. Just back; calling my doc's office today, still in pain. Will start my own thread shortly in the pre-TKR group as I have many questions about what to do now.


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  16. dmetz

    dmetz Junior Member

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    Agnes. I'm 59. I just had my right knee replaced on June 5 , 2017. My left one was replaced October 2016. I had cortisone injections for years. Also had all the gel injections. They stopped working. I don't want to si on the sidelines until I'm 70! I want to play now! My first replaced knee works like a dream! No pain. Takes me wherever I want to go. When the right knee couldn't keep up I scheduled the surgery. It is a blessing to walk without pain or a limp.

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  17. kneeper

    kneeper Forum Advisor Staff Member Forum Advisor

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    A second opinion sounds like a good idea to me. TKR is a big step and you don't want to jump (figuratively ;) ) at one, but it certainly seems like the shots aren't working well. That seems awfully frequently that you're getting them--my doc wouldn't do them more frequently than 3 months. (I'm reading this as cortisone, not some other injection, right?) And to try to set some sort of arbitrary age for surgery doesn't sound good to me.
    It could be that you don't need surgery yet, but I'd want a lot more of an evaluation and discussion of treatment options.
     
  18. Celle

    Celle Forum Advisor Staff Member Forum Advisor

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    I agree with your family doctor.
    The evidence of the MRI is clear - your knee needs to be replaced. I can't see any point in trying to wait until you are 70. With knee replacements nowadays lasting 30 years or more, what's the point of waiting?
    In addition if your physical health is good now, it may not be as good when you are 70.

    Your current surgeon may consider you are "too young" for a knee replacement, but that's a a very old-fashioned idea. Can you get a second opinion from another orthopaedic surgeon?
    Perhaps you could fill in this assessment chart, to see how much your knee is affecting your life - show it to your surgeon, too:
    Score Chart: How bad is my arthritic knee?

    These are the only ways in which you are too young to have a knee replacement:
    • You are too young to be living your life in constant pain.
    • You are too young to have your mobility so badly compromised.
    • You are too young to be giving up the lifestyle you enjoy.
    • You are too young feel so old.
     
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  19. Agnes

    Agnes Junior Member
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    Thanks, everyone! It appears that the medical advice can be variable. I'm on vacation right now and trying to figure out if I can take the incline railway to the top of Lookout Mtn in Tennessee. I find myself looking at reviews of people who say getting in and out of the tram is awkward and is like climbing a ladder. I'm second guessing myself that I can do it. I'm not in terrible pain, but the knee feels unstable. The back of my knee has a burning pain when I am on my feet too long. Still, I'm determined to do what I want.
     
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  20. kayak59

    kayak59 Senior

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    Best of luck in whatever decision to make, @Agnes . I could never have thought two different orthopedic surgeons could have such different opinions, but they can. My first doctor -- who did my knees -- said a hip replacement was not necessary because there was nothing wrong with the femoral ball. And minimized the socket damage -- despite the fact that I was in his office on a walker putting all my weight on it and taking heavy duty pain meds. My next doctor, younger and a hip specialist, walked in the office and after saying "hello", told me "yes you need a hip replacement" -- based on the MRI and what I had written down about how it was affecting my life and preventing me from doing what I wanted. I really think quality of life should be a major determining factor in decisions like this -- both for the patient and the doctor. I'm 58 by the way!
     

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