And you know where this is going. There was no difference in knee pain at any time point across the two groups, though pain did decrease a bit in all patients. Thank you, placebo effect. No changes in function, stiffness or walk time either.

In fact the only thing that changed significantly between the groups was the change in cartilage thickness. Those who got steroid lost 0.16mm more cartilage than those who got saline, a statistically significant, if clinically indeterminate result.

Do steroids still have a role? I spoke with an Orthopedic Surgeon who pointed out that steroids should really only be used for flares of osteoarthritis, not as a long-term treatment strategy. He also mentioned that the pain relief is real, but short-lived, and may not have been captured by the every-three-month pain surveys the researchers conducted.

But with this trial showing potential cartilage loss, and somewhat shoddy older data, it’s hard to justify the procedure without citing anecdotal evidence. Hyaluronic acid injections, look out. You might be the next to feel the pinch.