Bone on Bone Knee Pain London — Why Steroid Injections Stop Working and What to Do Instead
If you have bone on bone knee arthritis and you have had steroid injections, you will almost certainly recognise this pattern. The first injection was brilliant. You could walk further, sleep better, forget about the knee for weeks. The second was good but not quite as good. By the third or fourth you were back in the clinic within a few weeks of the injection, and the relief barely lasted.
This is not bad luck. It is not that you are unusually resistant to treatment. It is a predictable and well documented consequence of what steroid injections actually do — and what they do not.
Understanding this matters because it changes the conversation about what to try next. And at Proback Clinic in Victoria, London, that next step is what we do every day.
Why Steroid Injections Work at First
Cortisone and its modern equivalents are powerful anti-inflammatory agents. When injected into an arthritic knee joint they suppress the inflammatory cascade that is generating the pain, heat and swelling. For a joint that is acutely inflamed this can produce dramatic and rapid relief — sometimes within 48 hours.
The problem is that the relief is entirely dependent on the suppression of inflammation continuing. As the steroid is absorbed by the body over weeks or months the inflammatory process restarts and the pain returns. The underlying structural damage — the cartilage loss, the ligamentous laxity, the bone on bone contact — has not been touched. It is exactly as it was before the injection.
Why They Stop Working Over Time
With repeated steroid injections two things happen simultaneously that explain the diminishing returns.
First the joint adapts to the suppression. The inflammatory mediators that the steroid is blocking find alternative pathways and the duration of relief shortens. This is a well recognised phenomenon in pain medicine and is one of the reasons clinical guidelines recommend limiting steroid injections to three or four per joint per year.
Second — and this is the part that is not always clearly communicated — the steroid itself is causing damage. Multiple published studies have now demonstrated that repeated corticosteroid injections into osteoarthritic joints accelerate cartilage breakdown. The very tissue you are trying to protect is being progressively destroyed by the treatment that was supposed to be helping it. Each injection may be buying short term relief at the cost of long term joint health.
By the time steroid injections have stopped working reliably for a bone on bone knee the joint is often in a worse structural state than it was when the injections started. This is the situation many of the patients we see at Proback are in when they first come through the door.
What We Do Differently
Prolozone and Prolotherapy work in the opposite direction to steroids in almost every meaningful way.
Rather than suppressing the body’s response we are working with it. Prolozone — medical grade ozone injected directly into the knee joint — improves oxygenation and circulation within the joint, reduces chronic inflammation through a completely different mechanism to steroids and stimulates the cellular regenerative processes that the arthritic joint has lost. The anti-inflammatory effect is sustained rather than temporary and it does not come at the cost of tissue breakdown.
Prolotherapy addresses the structural picture that steroids ignore entirely. The ligaments and soft tissue structures around a bone on bone knee are under enormous stress and have typically been stretched, damaged or chronically strained over years of compensating for the deteriorating joint. Prolotherapy — a natural dextrose solution injected precisely into these structures under ultrasound guidance — stimulates new collagen production and progressively restores the structural integrity of the joint from the outside in. As the surrounding architecture stabilises the abnormal loading patterns that have been accelerating the cartilage loss are reduced.
The two treatments together address both the inflammatory environment within the joint and the structural instability around it. This is why we consistently see improvement in bone on bone knees where repeated steroid injections have produced only temporary and diminishing relief.
What Patients Tell Us
The most common thing we hear from patients who come to us after steroid injections have stopped working is that they wish they had found us sooner. Not because Prolotherapy is a miracle — it is not — but because the months or years spent on steroid injections that were progressively working less well were months and years in which their joint was continuing to deteriorate.
The earlier regenerative treatment is started the more joint tissue there is to work with and the better the outcomes tend to be. This is not a reason to panic if you have had multiple steroid injections — we see excellent results in patients who have — but it is a reason not to keep repeating an approach that has clearly stopped producing adequate relief.
What to Do Next
If steroid injections have stopped working for your bone on bone knee and surgery feels like a step you are not ready to take yet — come and talk to us. Our consultation gives you a full clinical picture of your knee, an honest assessment of what we can realistically achieve for your specific joint and a treatment plan with full pricing before you commit to anything.
Our initial consultation is on special offer at £110 — reduced from £270. Proback has delivered over 10,000 regenerative injection procedures and is the official UK training partner of the European School of Prolotherapy.
Give us a call on 0207 976 6648 or email victoria@proback.co.uk. We are at 4 Evelyn Mansions, Carlisle Place, Victoria, London SW1P 1NH — five minutes from Victoria station.
Frequently Asked Questions
Why have my knee steroid injections stopped working?
Steroid injections provide temporary relief by suppressing inflammation but do not repair the underlying structural damage. With repeated use the joint adapts to the suppression and the duration of relief shortens. Published evidence also shows that repeated steroid injections accelerate cartilage breakdown over time — meaning the underlying problem worsens with each injection.
How many steroid injections are safe for a knee?
Clinical guidelines generally recommend no more than three to four steroid injections per joint per year and no more than a limited number over the lifetime of the joint. Beyond this the risk of accelerating cartilage breakdown and weakening surrounding tissue becomes significant.
Is Prolozone safe after multiple steroid injections?
Yes — Prolozone and Prolotherapy are safe to use after steroid injections. We would typically wait four to six weeks after a steroid injection before beginning regenerative treatment to allow the steroid to clear and the natural inflammatory environment to re-establish.
How quickly will I notice improvement with Prolozone and Prolotherapy?
Most patients notice meaningful improvement from session two or three — typically within four to six weeks of starting treatment. The improvement tends to be progressive rather than immediate as the joint environment improves and new collagen is laid down over the course of treatment.
Can Prolozone and Prolotherapy work if I have very little cartilage left?
Yes — we treat bone on bone presentations regularly and see meaningful results even with very little cartilage remaining. We cannot regenerate cartilage that is no longer there but we can dramatically improve the joint environment, reduce pain and strengthen the surrounding structures — which translates into meaningful improvement in pain and function for most patients.
What is the difference between Prolozone and steroid injections?
Steroid injections suppress inflammation temporarily and can accelerate tissue breakdown with repeated use. Prolozone uses medical grade ozone to improve oxygenation within the joint, reduce chronic inflammation through a different mechanism and stimulate the body’s own regenerative processes. The effect is sustained rather than temporary and supports tissue health rather than degrading it.
Give us a call on 0207 976 6648 or email victoria@proback.co.uk.
Proback Clinic, 4 Evelyn Mansions, Carlisle Place, Victoria, London SW1P 1NH. Five minutes from Victoria station.
