Patient question

Steroid, hyaluronic acid or PRP: which knee injection is right for me?

Dr. Pablo GelberOrthopaedic Knee Surgeon

Quick answer

Steroid injections usually calm a painful flare quickly but briefly. Hyaluronic acid gives modest, variable relief for some people with arthritis. PRP shows encouraging but mixed evidence in mild to moderate arthritis. None rebuilds worn cartilage, and the choice depends on your knee, explains Dr. Pablo Gelber, knee surgeon at Aman Hospital in Doha.

Corticosteroid (cortisone) injections

A steroid is a strong anti-inflammatory. In a swollen, painful arthritic knee it often eases symptoms within a few days, and relief commonly lasts a few weeks, sometimes a few months. Evidence for short-term benefit is reasonably consistent, but the effect wears off and is less clear with repeated injections. It is useful to settle a flare so you can get going with physiotherapy, or to help over an important period such as travel or a family event.

Hyaluronic acid (gel) injections

Hyaluronic acid is a component of normal joint fluid. Injections, given as a single dose or a short course, aim to improve lubrication and reduce pain. The effect, if it comes, is slower than a steroid and may last several months. Research results are mixed: some studies show modest benefit, others little more than placebo, and international guidelines disagree on whether to recommend it. Some patients with mild to moderate arthritis feel it helps; others notice no change.

Platelet-rich plasma (PRP)

PRP is made by taking a sample of your blood, spinning it to concentrate the platelets, and injecting that into the knee. Platelets release growth factors that may calm inflammation. In mild to moderate osteoarthritis, a number of trials suggest PRP can reduce pain for six to twelve months, sometimes more than hyaluronic acid, but other good-quality trials have found no clear benefit over placebo. Preparation methods vary widely, which makes results hard to compare.

How the choice is made

Short-term relief of a swollen flare: steroid is often considered
Mild to moderate arthritis, wanting to avoid repeated steroids: hyaluronic acid or PRP may be discussed
Advanced bone-on-bone arthritis: injections usually help less, and surgical options may be more relevant

All injections tend to help more alongside exercise, weight management and activity changes, not instead of them. Dr. Gelber at Aman Hospital will examine your knee and review X-rays before suggesting whether an injection is likely to help.

Frequently asked questions

Can I combine different injections?

Sometimes, but there is little good evidence that combining them works better. It is usually clearer to try one approach and assess the response.

Are injections done under ultrasound?

Many knee injections can be given accurately using landmarks. Ultrasound guidance may be used when there is little fluid or the anatomy is difficult.