My knee injections have stopped working. What comes next?

Why injections stop helping

In arthritis, injections often help most in earlier stages. As cartilage wear advances, inflammation is only part of the problem, and the relief tends to shorten. In other knees, the pain may be driven by a mechanical problem, such as a loose fragment or a torn meniscus flap, by alignment, or by pain referred from the hip or back. Repeating the same injection rarely solves any of these.

A fresh assessment

A review usually includes examination, standing X-rays to see how much joint space remains, and sometimes long-leg X-rays to check alignment or an MRI if a structural problem is suspected. Dr. Gelber also asks how much the knee limits your work, prayer, sleep and walking, because that, not the X-ray alone, guides whether surgery is worth considering.

Options that may come next

• Revisiting physiotherapy, with a more targeted strengthening programme
• Weight management where relevant, which reduces load on every step
• An unloader brace for arthritis affecting one side of the knee
• High tibial osteotomy for younger, active patients with bow legs and inner-knee wear
• Partial knee replacement when wear is limited to one compartment
• Total knee replacement when the whole joint is affected and quality of life is poor
• Arthroscopy only in selected cases with a clear mechanical cause, as it is not a treatment for arthritis itself

Making the decision

Surgery is a choice, not an obligation, and the right time depends on your symptoms, age, activity and general health. Many patients in Doha prefer to understand all options before deciding. A consultation lets you weigh the likely benefits, recovery and risks of each path against carrying on as you are.