In a 2020 New England Journal of Medicine study of 156 patients Deyle et. al. demonstrated-
Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1 year than patients who received an intraarticular glucocorticoid injection.
The clinical guidelines for the treatment of osteoarthritis of the knee emphasize education, exercise, and (if appropriate) weight loss, rather than the use of drugs or surgery. A 2015 JAMA study compared PT vs, injection plus PT and showed no difference in patient outcomes over 14 weeks. The Orthopedic team that I work with inform me that patients may decline physical therapy after injection because of significant pain reduction immediately after injection, previous physical therapy treatment with home exercise program, and high co-payments.
Bennell and Hunter conducted a survey in four European countries demonstrating that physical therapy, education, exercise, and (if appropriate) weight loss, were recommended to fewer than half the patients. In this survey, stronger painkillers were recommended in 52% of patients, and 36% were referred for surgery.
Intra-articular glucocorticoid injections are commonly used to treat osteoarthritis of the knee, partly because they are easy to administer, they involve fewer visits than other treatments, and patient compliance is not an issue. But the benefits may be short-lived.