Cortisone Shots May Worsen Knee Arthritis (Study)
Research confirms repeated cortisone injections accelerate cartilage breakdown. RSNA findings and safer alternatives.
By Joint Pain Authority Team
Quick Answer
A growing body of research — including findings presented at the Radiological Society of North America (RSNA) — shows that repeated cortisone injections can accelerate cartilage breakdown in arthritic knees. Rather than slowing disease, frequent steroid shots may speed up joint deterioration and bring patients closer to knee replacement surgery. Evidence-based alternatives like hyaluronic acid injections now offer longer-lasting relief without the same cartilage risks.
What the RSNA Research Found
The Radiological Society of North America is one of the world’s largest medical imaging organizations. When RSNA researchers publish findings on joint health, the orthopedic community takes notice.
Recent RSNA imaging studies used advanced MRI techniques to track what happens inside knees that receive repeated cortisone injections. The results were striking:
- Accelerated cartilage thinning visible on MRI after serial corticosteroid injections
- Greater joint space narrowing compared to patients who received other treatments or no injections
- Structural changes in the subchondral bone beneath the cartilage
- No long-term pain advantage over patients who received placebo injections
These imaging findings align with a broader pattern in the medical literature that has been building for years.
How This Fits With Earlier Research
The RSNA findings do not exist in isolation. They confirm and extend what several major studies have already shown:
| Study | Key Finding |
|---|---|
| McAlindon et al. (JAMA, 2017) | Cortisone every 3 months caused greater cartilage loss than saline placebo, with no extra pain relief |
| Zeng et al. (JAMA, 2019) | Repeated cortisone linked to 57% higher risk of total knee replacement vs. hyaluronic acid |
| AJR Study (2023) | Continuous corticosteroid injections associated with 4.67x higher odds of radiographic OA progression |
| RSNA Imaging Studies (2025-2026) | MRI confirmation of accelerated structural deterioration after serial cortisone |
Taken together, the evidence points in one direction: cortisone provides short-term relief but may worsen the underlying disease over time.
Why Cortisone Damages Cartilage
To understand these findings, it helps to know what cortisone does inside the joint.
Corticosteroids are powerful anti-inflammatory drugs. When injected into a knee, they suppress inflammation quickly — which is why pain relief can be dramatic in the first few days. But that same powerful mechanism has harmful side effects on joint tissue:
In short, cortisone trades a few weeks of comfort for cumulative structural damage — damage that shows up clearly on advanced imaging.
What This Means for Patients
If you have knee osteoarthritis and have been receiving cortisone shots, this research does not mean you need to panic. Here is what to take away:
Occasional Use Is Different From Repeated Use
One or two cortisone injections per year for a severe flare-up is a different situation than getting shots every 3 months as a routine management strategy. The research showing harm is most concerning for repeated, regular cortisone use.
Relief Duration Matters
If your cortisone shots are lasting shorter and shorter periods, that is a sign the treatment is losing effectiveness while the cartilage risks continue to accumulate. This is a signal to discuss alternatives with your doctor.
You Have Options
The most important takeaway is that cortisone is not the only injectable treatment for knee arthritis. Alternatives with different risk profiles include:
Questions to Ask Your Doctor
If you are currently receiving cortisone injections, consider bringing these questions to your next appointment:
- How many cortisone shots have I had in this knee over the past 2 years?
- Given this new research, should we reconsider my injection plan?
- Am I a candidate for hyaluronic acid injections instead?
- Does my insurance (including Medicare) cover alternatives to cortisone?
- What does my latest imaging show about my cartilage?
The Bottom Line
The RSNA research adds MRI-level confirmation to what clinical studies have been showing for years: repeated cortisone injections accelerate cartilage damage in arthritic knees.
This does not mean cortisone should never be used. For acute flares or occasional relief, it still has a role. But as a routine, long-term strategy for managing knee osteoarthritis, the evidence now clearly favors alternatives that provide lasting relief without harming joint tissue.
If cortisone has been your go-to treatment, talk to your doctor about whether a different approach might better protect your joint for the long run.
Frequently Asked Questions
Does one cortisone shot cause permanent damage?
A single cortisone injection is unlikely to cause significant lasting harm to your cartilage. The research showing accelerated damage involves repeated injections over months or years. Occasional use for a severe flare-up remains a reasonable option.
How is this study different from earlier cortisone research?
The RSNA findings use advanced MRI imaging to directly visualize cartilage changes after cortisone injections. Earlier studies relied more on indirect measures like joint space narrowing on X-ray or clinical outcomes like knee replacement rates. MRI provides a more detailed and earlier picture of what is happening to the cartilage.
Are gel shots (hyaluronic acid) safer for cartilage than cortisone?
Current evidence suggests yes. Hyaluronic acid injections have not been linked to cartilage damage in clinical studies, and some research indicates they may have a protective or neutral effect on cartilage. The 2019 JAMA study found HA was associated with significantly lower knee replacement rates compared to cortisone.
Does Medicare cover alternatives to cortisone?
Yes. Medicare Part B covers hyaluronic acid injections for knee osteoarthritis. Several FDA-approved gel injection brands are covered, including Synvisc, Euflexxa, and others. Talk to your provider about Medicare coverage for gel injections.
Should I stop cortisone injections immediately?
Do not make changes to your treatment plan without talking to your doctor. If you are concerned about the research, bring it up at your next visit and ask about transitioning to alternatives. Your doctor can help you weigh the risks and benefits based on your specific situation.
References
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McAlindon TE, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain. JAMA, 2017;317(19):1967-1975.
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Zeng C, et al. Intra-articular corticosteroids and the risk of knee osteoarthritis progression. JAMA, 2019. PubMed
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Radiographic OA progression with corticosteroid injections. American Journal of Roentgenology, 2023. AJR
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RSNA imaging findings on corticosteroid effects in knee osteoarthritis. Radiological Society of North America, 2025-2026.
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Comprehensive review of viscosupplementation. Orthopedic Reviews. Full Text
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Related Resources
- Cortisone Injection Risks: When Steroid Shots Backfire
- HA vs. Cortisone: Which Is Right for You?
- Why Doctors Are Moving Away From Cortisone Shots
- Cortisone vs Gel Shots: Latest Evidence
- Hyaluronic Acid Injections: Complete Guide
- Medicare Coverage for Gel Injections
This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before making changes to your treatment plan.
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