How to read this page
Most of these trials were in people in their fifties and sixties living in the community, younger than most aged care residents. The average age is given where the trial reported it.
Trials that compare a procedure with a sham or placebo procedure give the most reliable answer, because both groups then expect to benefit.
The procedures
Corticosteroid injection into the knee
Uncertain / conflictingAny benefit is short-term and uncertain, and repeated injections over two years did not help pain in one trial.
The evidence
A Cochrane review of 27 trials (1,767 participants) found a small to moderate reduction in pain in the first weeks, fading to no evidence of effect by six months. The evidence was low quality, larger trials showed smaller effects, and the authors judged it unclear whether there is a clinically important benefit at one to six weeks 34. In a two-year US trial of 140 people, average age 58, with knee osteoarthritis and synovitis, injections every 12 weeks led to slightly more cartilage loss than saline and no difference in pain 35.
In practice
The 2024 knee standard describes corticosteroid injection as an adjunctive, short-term option for pain relief, says long-term use is not supported, and notes that repeat injections may damage cartilage 13.
Hyaluronan (viscosupplement) injection into the knee
Not supportedLarge blinded trials show no clinically relevant benefit, with a small increase in serious adverse events.
The evidence
A meta-analysis of 89 randomised trials (12,667 adults) found that the apparent benefit shrank as trial quality rose. In the 18 large blinded trials the effect on pain was small (effect size −0.11, 95% CI −0.18 to −0.04), which the authors called clinically irrelevant, and in five unpublished trials it was absent. Serious adverse events were more common with treatment (risk ratio 1.41, 95% CI 1.02 to 1.97) 36.
In practice
The knee standard does not recommend hyaluronan, platelet-rich plasma or stem cell injections, citing evidence that they provide no benefit and involve significant expense 13.
Platelet-rich plasma injection into the knee
Not supportedNo better than a saline injection for pain or cartilage in a placebo-controlled trial.
The evidence
In an Australian trial of 288 people aged 50 and over, average age 62, with medial knee osteoarthritis, three weekly injections of platelet-rich plasma did not reduce pain at 12 months compared with saline (difference −0.4 on a 10-point scale, 95% CI −0.9 to 0.2) or slow cartilage loss. Participants, injectors and assessors were blinded 37.
Epidural steroid injection for lumbar spinal stenosis
Not supportedAdding a steroid to a local anaesthetic injection gave minimal or no short-term benefit.
The evidence
In a double-blind US trial of 400 people with lumbar spinal stenosis and moderate to severe leg pain, an epidural injection of glucocorticoid with lidocaine was compared with lidocaine alone. At six weeks there was no meaningful difference in disability (difference −1.0, 95% CI −2.1 to 0.1) or leg pain (−0.2, 95% CI −0.8 to 0.4) 38.
In practice
Both groups received an injection, so the trial does not show whether either is better than no injection 38.
Vertebroplasty for painful osteoporotic spinal fractures
Not supportedCompared with a sham procedure, vertebroplasty gave no important benefit.
The evidence
A Cochrane review included five trials against placebo (541 participants, mostly women, average ages 63 to 81). At one month, pain was 0.7 points better on a 10-point scale (95% CI 0.3 to 1.2), a 7% improvement against the 15% the reviewers regarded as clinically important, and they concluded there was no important benefit. Serious adverse events reported with vertebroplasty included osteomyelitis, spinal cord compression and respiratory failure 39. An earlier Australian sham-controlled trial of 78 people found no advantage at any time point 40.
Radiofrequency denervation for chronic low back pain
Not supportedAdding radiofrequency denervation to exercise did not produce a clinically important reduction in pain.
The evidence
Three Dutch trials across 16 pain clinics (681 people, average age 52) added radiofrequency denervation to an exercise program for facet joint, sacroiliac joint or combined pain. At three months, every difference in pain was below the two-point threshold set as clinically important (facet joints −0.18, 95% CI −0.76 to 0.40). The trials were not blinded 41.
Corticosteroid injection for shoulder pain
Uncertain / conflictingAny benefit may be small and short-lived.
The evidence
A Cochrane review of 26 small trials found that, for rotator cuff disease, injection under the acromion showed a small benefit over placebo in some trials and no benefit over anti-inflammatory tablets. For frozen shoulder, injection into the joint did better than physiotherapy at seven weeks (risk ratio for success 1.66, 95% CI 1.21 to 2.28). The authors concluded that any benefit may be small and not well maintained 42.
In practice
This review is from 2003, and its trials were small 42.
Questions worth asking about any procedure
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What is the expected benefit, and how long is it likely to last?
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What did trials comparing it with a sham or placebo find?
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What are the risks for this person, including travel, sedation and time away from the facility?
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What is likely to happen if it is not done?
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What does it cost, and who pays?
Related pages on this site
Sources cited on this page
- 13 Australian Commission on Safety and Quality in Health Care. Osteoarthritis of the Knee Clinical Care Standard. Sydney: ACSQHC; first released 2017, revised August 2024. (Scope: people aged 45 and over.) View source
- 34 Jüni P, Hari R, Rutjes AW, et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015;(10):CD005328. View source
- 35 McAlindon TE, LaValley MP, Harvey WF, 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(19):1967–75. (Single US centre; mean age 58 years.) View source
- 36 Rutjes AW, Jüni P, da Costa BR, et al. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. 2012;157(3):180–91. View source
- 37 Bennell KL, Paterson KL, Metcalf BR, et al. Effect of intra-articular platelet-rich plasma vs placebo injection on pain and medial tibial cartilage volume in patients with knee osteoarthritis: the RESTORE randomized clinical trial. JAMA. 2021;326(20):2021–30. (Community participants in Sydney and Melbourne; mean age 61.9 years.) View source
- 38 Friedly JL, Comstock BA, Turner JA, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med. 2014;371(1):11–21. (LESS trial.) View source
- 39 Buchbinder R, Johnston RV, Rischin KJ, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev. 2018;11:CD006349. View source
- 40 Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361(6):557–68. View source
- 41 Juch JNS, Maas ET, Ostelo RWJG, et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the Mint randomized clinical trials. JAMA. 2017;318(1):68–81. (16 Dutch pain clinics; not blinded; mean age 52.2 years.) View source
- 42 Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003;(1):CD004016. View source
Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at November 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. It gives no doses, and it does not recommend any procedure, clinic or practitioner. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.
This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.