What to Do When Joint Injections Stop Working
If cortisone injections for osteoarthritis are wearing off faster, or you're looking for something other than another shot, here's another non-surgical option to know about
How Cortisone Injections Work
A corticosteroid is an anti-inflammatory medicine injected into a joint. It may provide short-term relief, especially when inflammation or a flare is contributing to pain. Relief may begin within days and can last from weeks to a few months, but responses vary, and the injection does not restore cartilage. Repeated injections into the same joint require a careful discussion about timing, risks, diabetes, infection, and plans for possible surgery.
How Low-Dose Radiation Therapy (LDRT) Compares
Low-dose radiation therapy (LDRT) sits between an injection and surgery: it's non-invasive and outpatient, like an injection, without the recovery time of surgery. Some LDRT studies that followed patients for a year, such as the German ArthroRad trial, found pain was still improved at 12 months, although those studies did not include a sham group.[5] Relief from a single steroid injection typically lasts weeks to a few months. There are no needles, no sedation, and no recovery period. A full LDRT course involves six treatment sessions over about two to three weeks, each visit roughly 10 to 15 minutes.
As with effectiveness generally, exactly how LDRT compares to cortisone injections head-to-head in rigorous trials is still being studied. The site's LDRT success rates page summarizes the current evidence in more detail.
What the Research Says About Repeat Injections
Steroid injections are a standard, guideline-backed treatment. The American College of Rheumatology and Arthritis Foundation guideline strongly recommends them for knee osteoarthritis and conditionally recommends them for hand osteoarthritis.[1]
The open question is repeated use. In a two-year trial, 140 people with knee osteoarthritis received an injection every 12 weeks of either triamcinolone, a common steroid, or salt water (saline). The steroid group lost more cartilage, an average of 0.21 mm compared with 0.10 mm, and their pain was no better than the saline group's.[2] This does not mean a single injection is harmful, but it is one reason doctors are careful about how often they inject the same joint.
What the Research Says About LDRT
In a 2025 sham-controlled trial in knee osteoarthritis, 70.3% of patients who received 3 Gy met the study's response criteria at four months, compared with 41.7% of patients who received sham treatment.[3] An earlier Dutch trial using 6 Gy found no benefit over sham.[4] No trial has compared LDRT and steroid injections directly, so there is no head-to-head answer on which works better or lasts longer.
Signs It May Be Time to Look at Other Options
- Each injection helps for a shorter time than the one before
- You are needing injections in the same joint several times a year
- You have diabetes and injections raise your blood sugar for several days
- You are planning joint replacement surgery, since surgeons often avoid steroid injections in the months before an operation
- You would simply rather avoid needles
If any of these apply, it is worth asking your doctor what comes next. For some people that may be physical therapy or a different injection, and for others it may be a consultation about LDRT.
Side by Side
Cortisone Injection
Relief may begin within days; typically lasts weeks to a few months. Quick, in-office procedure. Repeated injections carry risks that require discussion with your doctor.
LDRT
Six outpatient sessions over 2–3 weeks. No needle, sedation, or recovery period. Some studies found pain still improved 12 months later. No trial has compared it head to head with injections.
For education only. LDRT is not right for every patient. Talk with your doctor about whether it makes sense for your situation.
For the clinical evidence behind LDRT's effectiveness, see our LDRT Success Rates page or the full reference list on FAQ.
References:
1. Kolasinski SL, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research. 2020. Article
2. McAlindon TE, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA. 2017;317:1967-1975. PubMed
3. Kim BH, et al. Clinical Effectiveness of Single Course Low-Dose Radiation Therapy in Knee Osteoarthritis: Short-term Results from the Randomized, Sham-Controlled Trial. ASTRO 67th Annual Meeting Late-Breaking Abstract LBA 06. 2025. Abstract
4. Mahler EAM, et al. Effectiveness of low-dose radiation therapy on symptoms in patients with knee osteoarthritis: a randomised, double-blinded, sham-controlled trial. 2019. PubMed
5. Niewald M, et al. ArthroRad trial: randomized multicenter single-blinded trial on the effect of low-dose radiotherapy for painful osteoarthritis: final results after 12-month follow-up. Strahlentherapie und Onkologie. 2024. PubMed
What to Do Next
What Is LDRT?
How the treatment works, the typical schedule, and what the evidence shows.
Am I a Candidate?
What programs generally look for before recommending LDRT.
Is It Covered by Insurance?
What Medicare and most commercial plans typically cover.
What to Expect
What a typical LDRT appointment and course of treatment looks like.
LDRT Success Rates
What the published response and pain-relief rates actually show.
Arthritis Basics
How common forms of arthritis differ and when to seek care.
Find LDRT Near You
Browse our directory of hospitals and cancer centers currently offering low-dose radiation therapy for osteoarthritis.
Find a Location Near You