Third injection barely lasted six weeks. Is this the sign you've run out of road?

61, right knee, bone on bone on the inner side according to last year's X-ray. I've been holding the line with steroid injections and until recently I'd have said successfully.

First one, January, gave me a good five months. Second one in June, more like ten weeks. Third one at the end of September and if I'm honest with myself it was wearing off by early November. Six weeks, give or take.

Meanwhile the list of things I've quietly stopped doing keeps growing. Gave up golf over the summer, "temporarily". Sleep is broken most nights because I can't find a position the knee agrees with. The doctor who did the last injection said something about diminishing returns and it's been rattling round my head since.

Those of you who've been here: is the injections-wearing-off-faster thing actually the sign? Or did some of you get more mileage by changing something else?

The shrinking window was exactly my pattern, and I tried the gel injections next hoping for a different answer. In my case they took the edge off for a while but they weren't a different answer, and they're not cheap. I don't regret trying, I regret expecting them to turn back the clock.

The sleep thing you mention was the detail that got my attention when I read your post. For me that was the line between "managing" and "pretending to manage". Only you know which side of it you're on.

My consultant put it in a way I've never forgotten: injections buy time, so the question is what you're buying the time for. Buying time to stay active and think clearly is one thing. Buying time to avoid a decision is another. I'm still on the management side of the fence myself, but that framing is what I check myself against every few months.

Brian T said:

Meanwhile the list of things I've quietly stopped doing keeps growing.

That sentence is the one I'd ask you to sit with, because it was my story too. I spent years telling myself one more injection, one more winter, and the whole time the list of things my knee had taken off me kept growing so gradually I never properly counted it. When I finally did write it down, the list was the argument, not the X-ray.

I left my replacement later than I should have, mostly out of fear, and the honest accounting is on this site so other people don't have to repeat it. The guide to the signs you actually need a knee replacement is the checklist version: injections wearing off faster and pain that wrecks sleep are both on it.

To be clear, nobody here is telling you to book surgery, and a forum couldn't tell you that anyway. What I'd say is: don't let the decision get made by default, one postponed month at a time. Ask for the referral conversation while you're still choosing, not once you've run out of choices.

Update, since I found half-finished threads maddening when I was reading here. Saw my doctor at the start of December, asked for the referral, consultation with a surgeon booked for late February. Made the list Margaret described and it was longer than I expected, which told me something.

Still hoping I'm somehow wrong and there's another year or two of road left. But at least the question is now in front of someone qualified to answer it. Will report back after February.