Joint injections Chandler: how the main choices differ

Cortisone aims for shorter-term relief

Cortisone can lower swelling and soreness for some people. It doesn't fix the joint part that caused the soreness.

Cartilage is the smooth padding over the ends of bones. Cortisone doesn't rebuild that padding when it has thinned.

Relief may start sooner than it does with gel. The catch is that relief may fade.

Tell your doctor about diabetes before choosing cortisone. It can raise your blood sugar for a short time.

Ask when to check your blood sugar afterward. Don't change diabetes medicine without talking to your doctor.

Knee gel, called viscosupplementation, has mixed results

This gel copies part of the slippery fluid inside a joint. It may take longer to feel than cortisone.

In studies, people given gel felt little better on average than people given saltwater. Researchers used saltwater to see whether the gel itself made a difference.

Find out whether the gel requires more than one visit. Also ask what comes next if you feel little relief.

Don't judge the gel from its medical name. Judge it by easier walking, sleeping, or stair use.

PRP comes from a sample of your own blood

To make PRP, the clinic draws some of your blood and spins it. The clinic keeps more platelets, the small blood pieces that form clots.

That result is concentrated PRP because it has extra platelets. Clinics don't all spin or mix the blood the same way.

That matters because studies haven't tested one single PRP mixture. Ask what relief the clinic expects for your joint.

Exercise, braces, medicine, and surgery remain possible choices. You can compare likely relief, cost, risk, and time.

Sources

1. The 2015 Cochrane review of 27 trials (1,767 participants) found intra-articular corticosteroid better than sham for knee OA pain (SMD -0.40, 95% CI -0.58 to -0.22; NNTB 8), but the benefit decayed with time: moderate at 1-2 weeks, small at 13 weeks, and no evidence of any effect at 26 weeks. All outcomes were graded LOW quality.

   Jüni P, et al. — Intra-articular corticosteroid for knee osteoarthritis.. Cochrane Database Syst Rev, 2015. DOI: 10.1002/14651858.CD005328.pub3.

2. In a 2-year double-blind RCT of 140 patients with symptomatic knee OA and ultrasound synovitis, 40 mg intra-articular triamcinolone every 12 weeks produced significantly greater cartilage volume loss than saline (index compartment cartilage thickness change -0.21 mm vs -0.10 mm; between-group difference -0.11 mm, 95% CI -0.20 to -0.03) with no significant difference in knee pain.

   McAlindon TE, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.. JAMA, 2017. DOI: 10.1001/jama.2017.5283.

3. A 2022 BMJ systematic review and meta-analysis of 169 trials (21,163 participants) found viscosupplementation produced only a small pain reduction versus placebo (SMD -0.08, 95% CI -0.15 to -0.02; about -2.0 mm on a 100 mm VAS), below the minimal clinically important difference, and trial sequential analysis indicated conclusive evidence of clinical equivalence with placebo since 2009.

   Pereira TV, et al. — Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis.. BMJ, 2022. DOI: 10.1136/bmj-2022-069722.

4. The RESTORE randomized trial (288 participants, leukocyte-poor PRP, 3 weekly injections) found no significant difference from saline placebo at 12 months in knee pain (-2.1 vs -1.8 points; difference -0.4, 95% CI -0.9 to 0.2) or in medial tibial cartilage volume (-1.4% vs -1.2%), with 29 of 31 secondary outcomes also showing no between-group difference.

   Bennell KL, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

5. The 2025 Cochrane living review of stem cell injections for knee OA (25 trials, 1,341 participants) found stem cell injection MAY slightly improve pain and function up to six months versus placebo (pain 1.2 points better on a 0-10 scale; function 14.2 points better on 0-100), but rated the evidence LOW certainty for both, downgraded for indirectness and suspected publication bias, with up to three larger RCTs withdrawn before reporting results.

   Whittle SL, et al. — Stem cell injections for osteoarthritis of the knee.. Cochrane Database Syst Rev, 2025. DOI: 10.1002/14651858.CD013342.pub2.

6. FDA's HCT/P guidance sets out the minimal-manipulation and homologous-use criteria that decide whether a human cell or tissue product is regulated solely under 21 CFR Part 1271 (section 361) or requires a biologics licence; cell-based orthopaedic injections that fall outside those criteria are unapproved drugs and biological products, and no cell-based product is FDA-approved to treat osteoarthritis.

   U.S. Food and Drug Administration — Regulatory Considerations for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use - Guidance for Industry and FDA Staff. U.S. Food and Drug Administration, 2020.

7. An analysis of 37 randomized PRP trials found no significant difference in qualitative conclusions or outcome scores between industry-affiliated and non-industry-affiliated studies; overall, 19 of 37 (51.4%) reported PRP as favourable and 18 (48.6%) found no difference from comparators.

   Ta CN, et al. — The Influence of Industry Affiliation on Randomized Controlled Trials of Platelet-Rich Plasma for Knee Osteoarthritis.. Am J Sports Med, 2023. DOI: 10.1177/03635465221140917.