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Knee Injections: Cortisone, PRP, and Hyaluronic Acid - Explained

physical therapist manipulating taped knee

For many people living with knee pain from osteoarthritis, injections can offer meaningful symptom relief, especially when daily pain begins to interfere with movement.

A 2025 systematic review and meta-analysis, which included 11 randomized controlled trials, found that combining platelet-rich plasma (PRP) with hyaluronic acid (HA)provided better pain relief and functional improvement than PRP alone in patients with knee osteoarthritis (KOA). HA is found in the synovial fluid your body produces in your joints. As such, HA injections help in the lubrication of joints as well as shock absorption. This study, one of the most comprehensive to date, reinforced a shift in modern orthopedics away from short-term symptom control toward biologically informed approaches that support joint function and tissue recovery.

Another 2024 study also showed that co-administering cortisone and hyaluronic acid together can improve pain outcomes compared to HA alone.

At Ortho Westmount, our clinical and academic teams follow this evolving research closely. Knee injections, when properly indicated, can bridge the gap between conservative therapies and surgical options. They are part of a larger continuum of care for individuals living with knee arthritis or persistent joint pain.

Why the Knee Joint Breaks Down

Osteoarthritis of the knee is a progressive condition marked by the gradual breakdown of cartilage, the smooth surface that allows the knee to bend and glide without friction. For people with osteoarthritis, cartilage thins and the underlying bone becomes irritated. Along with articular cartilage degeneration, inflammation develops, and the synovial fluid loses its lubricating quality, which leads to pain during normal movement. Over time, microscopic damage accumulates,which can lead to bone marrow lesions in areas of the bone right under the cartilage,which can be seen on imaging.

Lifestyle measures and physical therapy form the foundation of early management. Still, for many patients with knee osteoarthritis, conservative care isn’t enough to treat pain. In those cases, physicians may consider non-surgical supportive management options, such as intra-articular injections, before considering knee surgery.

Types of Knee Injections

Cortisone

Corticosteroid injections, often called cortisone shots, are among the most familiar treatments for arthritis pain. They act by suppressing local inflammation, which helps reduce swelling and discomfort around the joint. Many patients notice significant pain relief within days.

However, cortisone is not designed as a long-term solution. Relief typically lasts weeks to a few months. Intra-articular corticosteroid injection works best as a temporary measure, helping patients regain function while other treatments, such as strengthening programs or weight management, are implemented.

For patients with rheumatoid arthritis, cortisone may also be used to calm inflammation within multiple joints, though the underlying autoimmune process requires broader medical management.

Hyaluronic Acid

Hyaluronic acid injections, sometimes referred to as “gel shots,” target a different problem. In a healthy knee, the synovial fluid contains hyaluronic acid, a thick, elastic molecule that cushions the joint. In osteoarthritis, this fluid becomes thin and watery. Replacing it via knee gel injections with a manufactured form of hyaluronic acid can help restore lubrication and reduce mechanical friction.

The effect is often described as the knee “moving more smoothly”, manifesting gradually over several weeks and lasting for several months. These injections are often recommended for mild to moderate arthritis, where some cartilage remains to benefit from restored joint mechanics.

The term “three gel shots” usually refers to treatment regimens where the injection is given once weekly for three consecutive weeks, though single-injection options now exist.

Cortisone or Hyaluronic Acid: Which Is Better for Knee Pain?

Cortisone works quickly but temporarily. Hyaluronic acid takes longer to work but may last longer once effective. For patients with more advanced arthritis or joint swelling, cortisone often provides faster relief. For those with milder arthritis seeking sustained symptom control, hyaluronic acid may be more suitable. Some clinicians even combine the two. A 2024 study found that co-administering cortisone and hyaluronic acid in the same session can improve pain outcomes compared to HA alone, offering both the short-term benefits of cortisone and the extended benefits of hyaluronic acid.

Platelet-Rich Plasma (PRP)

Platelet-rich plasma represents a different category of injection entirely. It is a biologic treatment prepared from the patient’s own blood, spun in a centrifuge to isolate platelets rich in growth factors. When injected into the knee, these concentrated platelets release signaling molecules that may support tissue regeneration and reduce inflammation.

In the context of knee arthritis, PRP aims not just to relieve pain, but to create a more favorable biological environment around the joint.

Still, outcomes depend heavily on preparation methods. PRP is not a single standardized product. Variations in platelet concentration, leukocyte content, and injection frequency all influence results. Some clinicians also combine PRP with intra-articular hyaluronic acid, leveraging the regenerative effects of PRP with the lubricating benefits of HA—a strategy now supported by emerging data such as the 2025 meta-analysis referenced above.

Safety

Regardless of the formulation, joint injections are generally well tolerated when performed by an experienced orthopedic professional. Mild soreness at the injection site is common, and temporary swelling may occur, but serious complications are rare.

When to Consider Other Options for the Treatment of Knee Osteoarthritis

Knee injections are an established way to treat osteoarthritis and reduce pain, however, they are not a magical cure. For many individuals, they can support patients as they implement physiotherapy and weight bearing exercises while also delaying the need for surgery while maintaining daily function. When joint damage progresses or pain becomes constant, surgical options may have to be considered.

For those seeking guidance, the team at Ortho Westmount provides expert insight to help patients understand the latest advances in managing hip and knee osteoarthritis.

To discuss your symptoms or explore evidence-based options for managing knee osteoarthritis, contact us. An informed approach, grounded in clinical experience and current research, remains the cornerstone of our orthopedic clinic care.

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