Cortisone before knee replacement may provide temporary relief from pain and inflammation caused by osteoarthritis. That relief can be useful, particularly when pain is interfering with walking, exercise, sleep, work, or daily activities.
However, a cortisone injection does not rebuild cartilage or reverse arthritis. If total knee replacement may be approaching, the timing of an injection also needs to be coordinated with your orthopedic surgeon.
What is in a cortisone injection?
A cortisone injection placed into your knee joint usually contains a corticosteroid medication. Examples may include triamcinolone acetonide, methylprednisolone acetate, or betamethasone. The specific medication and dose depend on the clinician, your medical history, and other individual factors.
The injection may also include a local anesthetic, such as lidocaine or bupivacaine. The anesthetic can produce temporary numbness or pain relief soon after the procedure. The corticosteroid works differently by reducing inflammatory activity inside your knee joint.
Because the anesthetic and corticosteroid work on different timelines, an immediate improvement does not necessarily show how much longer-term relief the injection will provide.
What cortisone before knee replacement may change
The American Academy of Orthopaedic Surgeons states that intra-articular corticosteroids could provide short-term relief for people with symptomatic knee osteoarthritis. Individual responses vary considerably. Some people report meaningful relief, while others notice little change or find that the benefit lasts for only a limited period.
When an injection reduces symptoms, it may become easier to walk, participate in physical therapy, complete strengthening exercises, sleep more comfortably, or manage necessary daily activities. That can make the temporary improvement useful even though the underlying arthritis is still present.
Temporary pain relief can create a useful window for activity, but it does not rebuild cartilage or reverse arthritis.
A helpful response to an injection does not mean that your joint surfaces have been restored. Cortisone affects inflammation and symptoms. It does not replace lost cartilage, correct a substantial joint deformity, or eliminate advanced osteoarthritis.
Using temporary relief productively
If cortisone gives you a period of improved comfort, consider discussing how to use that time with your physical therapist or medical team. Depending on your situation, that may include strengthening your legs, improving your general stamina, practicing functional activities, or preparing your home for surgery.
Prehabilitation can be valuable before total knee replacement. Building strength and capacity, learning exercises, and understanding what to expect may help you enter surgery with a stronger starting point and greater confidence in the process.
Do not use temporary pain relief as a reason to make a sudden, dramatic increase in activity. Your symptoms may be lower even though the arthritic changes inside your knee remain. A gradual approach gives you a better opportunity to observe how your knee responds.
If you are preparing for surgery, The Knee Replacement Game Plan™ was created to help you understand your starting point, prepare physically and mentally, and participate more confidently in your total knee replacement journey.
What research says about repeated injections
Questions about cartilage often arise when cortisone injections are repeated. In a randomized clinical trial, participants received either 40 milligrams of triamcinolone or saline every three months for two years. The triamcinolone group experienced greater cartilage volume loss and did not have a significant pain advantage over the saline group.
That study evaluated a specific schedule of repeated injections. It does not prove that one occasional cortisone injection will produce the same result. It does support having a thoughtful conversation about the expected benefit, frequency of injections, alternatives, and your longer-term plan.
There is no single injection schedule that is appropriate for everyone. Your diagnosis, previous response, health conditions, current medications, and potential surgical timeline all contribute to the decision.
Why timing before surgery needs attention
Research has found an association between corticosteroid injections given close to total knee replacement and an increased risk of infection around the new joint. Much of this evidence comes from observational studies, so it identifies an association rather than proving that the injection directly caused an infection.
A 2023 systematic review and meta-analysis found an increased risk of periprosthetic joint infection when an injection was administered within three months before total knee replacement. Because infection following joint replacement can be serious, many surgeons recommend avoiding a cortisone injection during that period.
Three months should not be treated as a universal guarantee or a rule that applies identically to every person. Surgeons and hospitals may use different policies, and individual health factors may affect the recommendation.
If you are considering an injection and surgery may occur within the next several months, contact your orthopedic surgeon before receiving the injection. Ask how long the surgeon requires between an injection and surgery. Keep a record of the date, medication, dose, and which knee received the injection.
Other considerations before an injection
Cortisone injections can have side effects. Some people experience a temporary increase in pain after the injection. Blood glucose may rise, particularly in people with diabetes. Skin color changes, thinning of tissue near the injection site, and infection are also possible, although serious complications are uncommon.
Your clinician needs to know about diabetes, blood-thinning medication, current infections, allergies, recent injections, and a possible surgical date. Ask what changes would require a call to the office after the procedure.
The decision is not simply whether cortisone is good or bad. The useful questions are what you want the injection to accomplish, how likely it is to help with that goal, how it fits into your preparation, and whether the timing is compatible with your surgical plan.
Continue the injection series
This is the first episode in the series Before Total Knee Replacement: What Injections Really Do. The next episode examines gel injections, also called hyaluronic acid injections, and explains how their purpose and supporting evidence differ from cortisone.
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References
- American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty): Evidence-Based Clinical Practice Guideline. 3rd ed. Published August 31, 2021.
- McAlindon TE, LaValley MP, Harvey WF, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA. 2017;317(19):1967-1975. doi:10.1001/jama.2017.5283
- Kim YM, Joo YB, Song JH. Preoperative intra-articular steroid injections within 3 months increase the risk of periprosthetic joint infection in total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2023;18(1):148. doi:10.1186/s13018-023-03637-4
- Lai Q, Cai K, Lin T, et al. Prior intra-articular corticosteroid injection within 3 months may increase the risk of deep infection in subsequent joint arthroplasty: a meta-analysis. Clin Orthop Relat Res. 2022;480(5):971-979. doi:10.1097/CORR.0000000000002055
- Choudhry MN, Malik RA, Charalambous CP. Blood glucose levels following intra-articular steroid injections in patients with diabetes: a systematic review. JBJS Rev. 2016;4(3):e5. doi:10.2106/JBJS.RVW.O.00029
Educational Disclaimer: This article provides general educational information and is not medical advice. It does not diagnose a condition, recommend an injection for a specific person, or replace guidance from your surgeon, physician, physical therapist, or other licensed healthcare professional. Injection recommendations and surgical timing must be individualized. Seek prompt medical care for severe or concerning symptoms.