A recent study found steroid injections for a common condition that affects millions upon millions of Americans may be causing more harm than good. And in this study they looked at 459 patients with osteoarthritis. That’s the tear down a cartilage in your joint. They looked at them, one, two, three steroid injections and hips or knees for their joint pain. Of the patients in the study, 8% had complications that worsened the state of their joint. So they already had issues; 8%, it became worse.
In some cases the arthritis accelerated, and in other cases patients developed small little fractures under the cartilage. So complications that maybe we were all naive to. These things are ubiquitous, steroid injections. Here, they’re everywhere. [inaudible] now to discuss via Skype, orthopedic spine surgeon Dr. Hooman Melamed.
So, Dr. Melamed, [inaudible] may not realize how common steroid injections are for joint pain, joint osteoarthritis, but this is something, I’m assuming, when you were in med school and in your training, you were doing it a lot. Is that fair to say?
Yeah, I mean, you know, back 10, 15 years ago, 20 years ago, even five years ago, everybody’s doing the steroid injections. You know, we thought it was very good. If you would have asked me, I said, what are you talking about? But now we know that steroids are absolutely toxic to the joint. They kill the joints, basically. It is not good for the cartilage. We are born with certain amount of cartilage cells for our lifetime in our hips and knees, anywhere else in the body. Once they die, that’s it, you’re done. They are completely dead.
And, you know, we used to think a lot of the patients, oh my god, the doctor was great, injected with steroids, or I feel amazing. But what you don’t realize, you’re masking the problem now. And you actually, when the effects wear off, you’re far worse off than what you were before you have [inaudible]. As you said, yes, it kills the cartilage, causes fractures below the bone, and starts basically destroying the foundation of the joint itself. You end up far worse than what you should have been when you start it, basically.
Dr. Melamed, I’m so curious, because 8% as a rate of complication, it’s actually quite high. I mean, when you first think about it, it doesn’t sound so bad, but then you think about how many millions of these procedures are being performed. So I’m curious if you could give us some maybe tips or pointers about who’s most at risk.
Well, very important, everybody is at risk. You know, everybody honestly is at risk of when they get this steroid injections, especially the younger you are. If you get these into your joints, basically you are basically much higher risk of having destruction of your joint, which is, you know, for somebody who is 40 years old, or some of the athletes we see getting the injections so they can get back onto playing, you know, you’re destroying that person’s joint for the rest of their life. And it’s a very debilitating problem as a young person having a joint problem. So I would say everybody’s at risk, basically.
I know that when, when you get steroid injections, it’s mixed with lidocaine, and I know there’s, there’s studies that show that lidocaine may also be toxic to the joint space and directly to the cartilage tissue. So when you combine the two factors and you create… I know that orthopedic surgeons that treated me, they said, well, it created this cascade that your cartilage just started breaking down, and no matter what we followed up with, and they did stem cells, PRP, it was all done, it was too late. You couldn’t stop this process. That’s the cartilage went, and people end up having to get joint replacements.
That’s correct. A lot of times they used to use the, for example, the lidocaine after surgery for pain control, and they turn out these patients end up with horrific arthritis afterwards. So you combine the steroid with the lidocaine, you end up with far worse than individually alone.
Well, true story, Dr. Melamed, and when I was in my 20s in med school, I developed severe bilateral turf toe, essentially. I was getting about every four to six months injections of lidocaine and steroids into my big toe joint. At my age now, I have literally no cartilage left. It’s like bone on bone. And I’ve been, you know, and it’s funny, because back then it would give me pain relief, and so the, and that once that pain relief, it would last for a while, and then it would come back, without realizing, getting worse, go back in for more injections.
And I was doing this, you know, just constantly thinking that, oh, I’m like, I get this done, I can still go play basketball and go rock climb. I think, you know, I wish we had done these studies. I looked at this for sure 25, 30 years ago.
