“I went to the same orthopaedic doctor who operated on my meniscus twice.

He suggested hyaluronic injection that also contains cortisone and an anesthetic.

I am a bit skeptical as it contains cortisone.”

Is cortisone as bad as they say or is it maybe just demonized like deep squats were back in the day?

Why do they give cortisone if it is so bad?”

This is from an email that I received last week.

And it’s a question that I get from clients, family and friends.

Because if you’ve seen a doctor for knee pain, you’ve likely been offered injections.

But not all injections are created equal.

Different types of injections provide different benefits.

And some injections carry greater risks.

Cortisone – also known as corticosteroid or steroid injections – often do a good job of swiftly eliminating inflammation.

Knee inflammation includes symptoms like warmth, swelling, and pain.

So if your knee is swollen or painful, this type of injection may promptly and significantly reduce your symptoms.

The degree to which symptoms decrease as well as how long this decrease lasts varies from person to person.

A 2020 systematic review of eight randomized control trials revealed “a mild to moderate effect on pain severity up to 3 months after the injection.” (source)

Another meta-analysis, published in 2024, examined the results from 11 randomized control trials.

These researchers determined “corticosteroid injections offer clinically perceivable pain relief” lasting up to 6 weeks. (source)

In the past, it was unclear whether cortisone (steroid) had any harmful side effects.

For example, a 2003 research article studied 68 people with knee osteoarthritis who received cortisone (steroid) injections every three months for two years.

These scientists concluded, “No deleterious effects of the long-term administration of [steroid injections] on the anatomical structure of the knee were noted.” (source)

However, there is more and more recent evidence that cortisone (steroid) injections can be harmful. (source)

The Journal of Osteoarthritis and Cartilage published a 2019 article, revealing that these injections are associated with worsening knee X-rays, especially after having multiple injections. (source)

And cartilage has been shown to get thinner based on the MRI results of people who received injections every three months for two years. (source)

But the risk of causing more damage to your knees is not only with frequent injections.

There is also evidence indicating that long-term damage can occur even with a single cortisone injection.

A 2020 study of 3,822 patients with knee arthritis found that each corticosteroid injection increased the risk of knee replacement by 9.4% at 9-year follow-up. (source)

I’ve talked about my concerns here:

This is a fair – and important – question.

One reason is that medicine changes slowly.

On average, it takes about 17 years for scientific evidence to meaningfully change medical practice. (source)

That means treatments can remain common long after newer research has raised legitimate concerns about their long-term effects.

Cortisone injections became popular decades ago because they often work – at least in the short term.

They reliably reduce inflammation and pain, and for many physicians and patients, that immediate improvement feels like success.

When someone is hurting, swollen, and desperate for relief, a fast-acting option is understandably appealing.

However, as evidence has evolved, the confidence behind these injections has weakened.

In fact, the American Academy of Orthopaedic Surgeons (AAOS) addressed this directly in their latest 2021 international clinical practice guidelines, stating:

“We are unable to recommend for or against the use of intraarticular (IA) corticosteroids for patients with symptomatic osteoarthritis of the knee.” (source)

That statement is striking.

It reflects uncertainty – not endorsement.

So why are cortisone injections still widely used?

In my experience, it often comes down to a short-term mindset.

Many people are understandably focused on feeling better now.

And in a limited number of cases, short-term relief may be appropriate:

A severe inflammatory flare
A one-time event someone needs to get through
A bridge to another strategy

In those situations, a cortisone injection can be a calculated choice.

The problem arises when short-term relief is repeatedly prioritized without addressing why the knee is inflamed in the first place.

Or when injections are presented as low-risk, long-term solutions despite growing evidence to the contrary.

Reducing knee pain temporarily is not the same as improving knee health.

What did I tell the person who asked whether or not to get the combination injection of hyaluronic acid, cortisone and an anesthetic?

Well, here’s some important information:

He does not have knee pain with most of his daily activities (cleaning house, cooking, gardening).

But when he attempts challenging leg workouts at the gym, he experiences knee pain the next day.

And it takes a couple days for this knee pain to go away.

He doesn’t need to eliminate a large amount of knee inflammation.

Instead, the inside of his knee must be stronger to withstand the forces of the exercises he wants to do.

Cortisone won’t give him that result, and it may actually work against this goal.

Cortisone injections can reduce pain and swelling – but usually only for a few weeks or months.
Newer research raises real concerns about cartilage loss and joint damage.
These risks may increase with repeated injections—and possibly even after one.
Medical practice often lags behind research by nearly two decades.
Treatments can remain common long after evidence becomes less favorable.
The AAOS does not recommend for or against cortisone injections for knee arthritis.
That uncertainty matters when making informed decisions.
Pain relief is not the same as knee health.
The real question is how to reduce inflammation and protect your joint long term.