Cortisone Before a Knee Replacement? What a New Study Found

A multicenter group of anesthesiology and pain researchers across the US and Canada pulled a national insurance claims database and asked a simple question: among patients who had never been on opioids, does getting a corticosteroid in the month before a knee replacement change anything downstream? 27,510 patients had a steroid claim in those 30 days. Whether that was an injection into the knee, a shot in the muscle, or an oral steroid pack. At three months after surgery, 18.2 percent of them had opioid prescriptions, compared to 12.9 percent of the 736,020 patients with no steroid claim. At six months it was 8.8 percent versus 6.8 percent. I'm Dr. Nikhil Verma, an interventional spine and musculoskeletal physician in Columbus, Ohio. I run Essential Sports and Spine Solutions, where most of what we do is regenerative medicine and image-guided procedures. In this video I walk through what that study found, why the mechanism makes sense, and one opioid-free option I use in my office for knee pain: iovera°, an ultrasound-guided cryoneurolysis procedure that uses cold rather than heat on the genicular nerves around the knee. WHAT I COVER 0:00 Why cortisone became the default for knee osteoarthritis 1:05 The study, the numbers, and what it actually measured 2:40 The mechanism: why blunting inflammation early may cost you later 3:50 What iovera° cryoneurolysis is and how it differs from heat ablation 5:10 Up to 90 days of relief, range of motion, and the first 72 hours after surgery 7:20 Insurance, Medicare, and self-pay reality 8:30 What I'd want to know if this were my knee THE STUDY Hussain N, Brull R, Gilron I, et al. Association of preoperative corticosteroids with persistent opioid requirements following total knee arthroplasty: an exploratory population-based cohort study. Canadian Journal of Anesthesia. 2026;73:243-252. Author group spans Ohio State, University of Toronto, University of Ottawa, Queen's University, Mayo Clinic, University of Minnesota, and St. Michael's Hospital. This is a retrospective claims-based cohort study. Adjusted odds ratio 1.34 at three months and 1.20 at six months. It shows an association, not proof of cause, and the authors say so directly. ON IOVERA° Cryoneurolysis applies cold to a peripheral nerve to interrupt the signal. The effect is temporary and lasts until the nerve regenerates, which the data puts at up to about 90 days. A randomized controlled trial of cryoneurolysis performed three to seven days before knee replacement found lower opioid use and better pain scores in the treated group. I have no financial relationship with the company that makes the device. If you're in Columbus, Dublin, Westerville, Upper Arlington, or Gahanna and you're staring down a knee replacement, or you've been handed the cortisone-then- surgery script without anyone walking you through the options, request a visit here: https://www.essentialsportsspine.com/... I go deeper on the protocols I actually use, how I select systems, and what I tell every patient after a procedure in my newsletter, Essentials of Healing: https://nikhilvermamd.substack.com essentialsportsspine.com nikhilvermamd.substack.com    / @drnvsportsspine   instagram.com/drnvsportsspine instagram.com/essentialsportsspine linkedin.com/in/nikhil-verma-m-d-951b57b8 x.com/DrNVSportsSpine facebook.com/essentialsportsspine This is for educational purposes only and does not constitute medical advice. I may be a doctor, but I am not your doctor. #kneepain #kneeosteoarthritis #kneereplacement #cortisone #regenerativemedicine #ColumbusOhio #interventionalpain #cryoneurolysis #iovera #opioidfree