Are Joint injections with cortisone dangerous?

Why osteoarthritis patients twice üsuperior should, whether you use these or other gängige syringes want to get in your aching joints

Knee examination: osteoarthritis can cause pain

As the osteoarthritis in the knee made with swelling and pain, he hoped to relieve by means of a syringe with a established Orthopäthe. The Patient end 50 received in the joint an injection of cortisone. Nothing Special. In German practices, a alltäof the urgency procedure.

But instead of the hoped-for rapid improvement in the complications escalated. With the syringe were germs in the joint, it is infected. The knee was several times gespült, antibiotics were administered, at some point, the cartilage had to be removed.

The joint had become unusable. But that’s not enough. Bacteria in Köbody überlebt. Even after the Insertion of an artificial joint, there were more Entzündungen. The Ädoctors saw no Chance to save the leg. They amputated it.

Größte disaster Amputation

"If this happens after a cortisone injection, which is a Katastrophe", the Orthop&auml says;din Christina Otto, Lambertz, the man in the Universitätsklinikum Köln treated. "Natüof course this happens rarely, but, nevertheless, this M&ouml is;of urgency." She warns, therefore, against a frivolous treatment with injections to the knee and other joints.

As Ärztin in a großs hospital with maximum supply, you see complications after cortisone injections häoften – in contrast to the established Orthopäthe the injection most of the time. With the locally-administered active ingredient you want to the acute Entzümaking a osteoarthritis bekäfight. Occur serious complications, küthe gro&szlig inhibitors be;en clinics.

Otto-Lambertz is üassured: "In Germany, there is a Übertherapie with cortisone injections." Not only to the Ädoctors, but also to the expectations of the patients. "It is quite firmly in the Kömake anchored that the Orthopäthe syringe gets, and then it has to go one better."

Cortisone injections are already used less frequently

The German society für Orthopäthe and trauma surgery (DGOU) indicates that the Ädoctors the Problem was aware of it. The früago widespread use is already zurückgegangen. "Cortisone should zur&uuml in osteoarthritis very;cautious be used. Only in the case of an acute Entzümaking thrust and sorgfäthe genuine Abwäaside the Before – and Nachteile", the Orthopäde Professor Philipp Niemeyer, of the DGOU says.

According to the Institute für medical statistics IQVIA are cortisone injections by Orthopäin the past three years, easily rückläfrequently. From December 2016 to November 2017 were made by Orthopäthe 387 000 Corticosteroid injections for cash patients. The fünf percent less than in the same period of the previous year. The injections come in the Orthopänot only in arthritis but also in Rücover pain, shoulder injuries, or Sehnen­approach-problems.

Risks associated with corticosteroid injection

Risk of infection: With the injection köcan germs in the Köbody get

Risk cartilage: cortisone injections köcan the cartilage to reduce

Risk Hormones: Häfrequent cortisone injections köcan köthe body’s own cortisone production stören

Study: After cortisone syringe cartilage dümen

Cortisone injections in the joints, the cartilage can suffer. Dafür there was läViking notes. Now a 2017 caught in the journal JAMA veröffent­­the light of the study of attention. The authors compared injections in the Knie­­joints of osteoarthritis patients – either with the corticosteroid triamcinolone, or with Kochsalzlösung. For two years the 140 participants received all three months in each case a syringe.

The result: There was no significant difference in knee pain. But who had been treated with cortisone, had on average a 0.21 mm dünneren cartilage. In the comparison group, the joint pad had decreased by only 0.10 of a Millimeter.

Pain in the syringe is reduced only in the short term

So ergäthe study complements a 2015 veröpublished Üreview the work of the renowned Cochrane network to cortisone injections for knee osteoarthritis, für were evaluated in the trials with 1767 participants. The authors come to a ernücompressor result.

After a short-term Schmerz­reduction of üusually one to two weeks gr&ouml showed;ßEUA, sorgfäthe genuine durchgefürigidity studies, no statistically aussagekräthe busy effect.

Weak evidence für the effectiveness of

"We were üsurprised how weak the evidence für the effectiveness of sind", the main author Professor Peter J&uuml says;ni. The Swiss leads the center für Clinical research at St. Michael’s Hospital at the Universität Toronto (Canada).

How could the method nevertheless, so strong? "This is an ancient therapy, the eingeführt was before it große, according to today’s scientific Standards durchgefürigidity studies gab", J&uuml says;ni.

Cortisone schwächt locally the defense

With each injection – and sorgfäthe genuine disinfection – köcan germs in the Köbody. In the case of cortisone, the risk is still something größhe, because it is the local immune defense schwächt. How groß the risk für infections, and other complications of a cortisone-injection, unfortunately, can not be determined exactly. Experts schäthe risk daf&uuml support;r to a maximum of two percent.

Only a fraction of patients with unerwüyou want to follow a therapy to complain officially due to a treatment error. "You schätzt that it’s just 1.5 to three percent to the display bringen", Gerhard Schillinger, head of AOK in the area of medicine says.

Evaluation of incorrectly administered cortisone injection

Für a 2012 in German Ärzteblatt veröpublished study Otto-Lambertz and other authors complications to Corticosteroid injections and evaluated dafür 278 einschlägige Fälle of the expert commissions and arbitration from the years 2005 to 2009.

They discovered the following error: The therapist has not spent enough on Hygiene, the cortisone injection was the clinical picture is not appropriate, the injections were a result of in the to poet, and to not be administered as a high dose, you landed in the right place. Infections have been misunderstood, and the patient is not üabout the risks aufgeklärt.

This was part of cortisone injections in the Wirbelsäule in Rücover pain and Depot injections in the Butt muscle in the case of allergies. "If an infection of the intervertebral discs is produced, can this up in the Rüblock mark channel will continue to further complications führen, such as Lähmungen", Otto-Lambertz says.

A typical Problem with the shot in the Butt muscle: The active ingredient ends up in the muscle, but remains in the darüberlie lowing fat tissue. Then the tissue can die on the spot and große, häterrible dents.

Hyaluronsäure as an Alternative?

Many Orthopäthe syringe today Hyaluronsäure to the inhibition of the Entzümaking. The cost of the health insurance Fund not üaccepted. Für the Ädoctors is billing as an Individual health service (IGeL) in any case, more attractive.

Many Orthopäthe are from the positive effects üassured – despite widersprüdoes results of the study. Große Uni-clinics in the Viscosupple&shy are;mentation (Hyaluronsäure, which is injected into joints), however, rather skeptical gegenüber. "I know patients who say that it has brought something to you. You’re after three to four months. But others say that they have no improvement in this spüren", the Orthopäde Dr. Arnd Steinbr&uuml says;ck, a senior physician in the Orthopäthe LMU hospital in MüMunich-Großrag.

He applies Hyaluronsäure not on. After all, the substance does not harm, in contrast to cortisone the cartilage. It is, however, no "Knorpelaufbauspritze", as is often claimed. "The wäre too much versprochen", Orthopäde Niemeyer says.

Pläleaves-rich Plasma as a further Option

More and more Orthopäthe also rely on so-called Pläleaves-rich Plasma (PRP). The Patien&shy is;th, blood was collected, it is centrifuged, and then the Blutpl&auml be;leaves (platelets) in the joint injected. Also in this method, a subset of patients from a Gef&uuml reported;hl of improvement. Osteoarthritis Sufferers should know that the procedure is considerably explored, less than Viscosupplementation. And this is still controversial.

Scientists Jüni is currently working to update of a Cochrane Üreview. The last analysis of 89 studies showed that the method is as good as ineffective. Because: Only small, methodologically inferior studies, which have a low explanatory power, as indicated by the positive effects. Große, methodically better studies show no effect.

Side effects möpossible

In addition, it can in the case of injections with Hyaluronsäure or PRP to infections and other side effects. The conclusion of researchers Jüni: "Osteoarthritis patients should be sure to all other therapy Möopportunities ausschöway to the top."

What you can do for yourself

Before osteoarthritis-Affected syringes in your joints, you should do this:

  • Who is too thick, you should definitely decrease, in order to relieve the joints. Advisable also orthop&auml are;Jewish deposits, the misalignment offset, and physiotherapy. With Üexercises the muscle corset gest&auml can;be rkt.
  • In the case of acute pain, the joint should be rested, elevated and gekübe the hlt. Vorütemporarily köcan pain medications such as Ibuprofen, or even prescription stästronger painkillers are taken.