Knee Arthritis: Steroid Injection vs Hyaluronic Acid Injection – Which Is Better?
- Daniel Taylor
- Aug 11
- 5 min read
Updated: 3 hours ago
Knee arthritis is a common condition that becomes increasingly prevalent from the fifth decade of life onwards (typically over the age of 50). However, in some cases the onset of knee arthritis can occur much earlier, which can be particularly challenging for individuals who wish to remain active and maintain a good quality of life.
Knee arthritis is characterised by the gradual loss and deterioration of cartilage within the knee joint. Cartilage acts as a protective cushioning layer between the bones, allowing the joint to move smoothly and efficiently. As part of the natural ageing process, the cartilage undergoes microscopic changes. One of the earliest changes is a reduction in its ability to retain water (its hydrophilic properties). As the cartilage loses hydration, it becomes less resilient, begins to dry out, crack and gradually break down over time. This process ultimately leads to joint degeneration and the symptoms associated with osteoarthritis.
What Causes Knee Arthritis?
There are many factors that can contribute to the development of knee arthritis. Some of the most common risk factors include:
Previous knee injuries such as ligament tears or meniscal injuries
Family history and genetic predisposition
Excess body weight
Poor dietary habits
Reduced levels of physical activity
Occupations involving repetitive kneeling, squatting, lifting or heavy manual work
Age-related wear and tear
Previous surgery to the knee
Whilst some risk factors cannot be modified, others such as weight management, exercise levels and general health can play an important role in slowing the progression of arthritis and reducing symptoms.
Early Treatment Options for Knee Arthritis
In the early stages of knee arthritis, many people can successfully manage their symptoms using simple conservative treatments. These may include:
Ice therapy to help reduce inflammation and pain
Anti-inflammatory medications such as ibuprofen (where appropriate)
Weight management
Activity modification
Strengthening exercises for the muscles around the knee
Maintaining knee joint mobility
One of the most effective ways to manage knee arthritis is through a structured exercise programme. Strong muscles around the knee help absorb forces that would otherwise be transferred directly through the arthritic joint.
For some simple knee arthritis exercises, please visit my YouTube channel:
📺 Knee Arthritis Exercises:
Whilst these measures can be highly effective in the early stages, many patients find that as the arthritis progresses they require additional treatment options to maintain their mobility and quality of life. This is where injection therapy can play an important role.
Steroid Injection vs Hyaluronic Acid Injection: Which Is Better?
There are two main injection options that I regularly discuss with patients suffering from knee osteoarthritis: corticosteroid injections and hyaluronic acid injections. Whilst both treatments can be effective, they work in very different ways and each has its own advantages and disadvantages.
Steroid injections are powerful anti-inflammatory medications that work by suppressing inflammation within the joint. Whilst osteoarthritis is primarily a degenerative condition, inflammation commonly develops as the cartilage deteriorates and the joint becomes irritated.
By reducing inflammation, steroid injections can provide significant pain relief and improve mobility.
How Long Does A Steroid Injection Last?
The relief obtained from a steroid injection is temporary. When we look at data from studies worldwide, the average duration of symptom relief is approximately 2–3 months, although some patients experience longer-lasting benefits and others may experience shorter periods of relief.¹
Steroid injections can be repeated as part of the long-term management of knee arthritis. In many cases, patients may receive between 3 and 4 injections per year, although this depends on several factors including:
Age
Severity of arthritis
Medical history
Response to previous injections
Presence of other health conditions
What Are The Risks Of Steroid Injections?
Whilst steroid injections can be extremely effective, caution should be exercised when using them repeatedly over long periods.
Potential risks include:
Osteoporosis
Adrenal suppression
Elevated blood sugars in diabetic patients
Increased infection risk
Gastrointestinal side effects
Potential acceleration of cartilage degeneration with repeated use²
For this reason, in younger patients (particularly those under the age of 55), I generally advocate a more cautious approach to repeated steroid injections and often discuss alternative treatment options such as hyaluronic acid injections.
Hyaluronic acid is a naturally occurring molecule found throughout the body and is particularly abundant within healthy joints and cartilage.
Its primary role is to help maintain hydration within the cartilage and joint fluid. This allows the cartilage to remain resilient, lubricated and capable of absorbing the forces that occur during walking, running and other daily activities.
How Does Hyaluronic Acid Work?
Hyaluronic acid works through several mechanisms:
✅ Improves joint lubrication
✅ Helps maintain cartilage hydration
✅ Enhances shock absorption
✅ Reduces friction between joint surfaces
✅ Forms a protective coating over cartilage
✅ May reduce the activity of inflammatory cells within the joint
As hyaluronic acid is a substance naturally found within the body, it has an excellent safety profile and does not carry the same systemic side effects associated with corticosteroid injections.³
Why I Often Prefer Hyaluronic Acid In Younger Patients
In younger patients with knee arthritis, hyaluronic acid injections are often my preferred treatment option.
Unlike steroids, hyaluronic acid injections can be repeated multiple times without concerns regarding:
Osteoporosis
Adrenal dysfunction
Blood sugar disturbances
Systemic steroid exposure
This makes them particularly attractive for patients who may require ongoing treatment over many years.
Which Injection Lasts Longer?
Interestingly, research suggests that corticosteroid injections often provide superior pain relief during the first 4–6 weeks after treatment. (Its important to note that both give relief at 4-6 weeks) However, studies have shown that hyaluronic acid injections frequently provide longer-lasting benefits, with many patients continuing to experience relief at 6–9 months after injection.⁴
This difference is one of the main reasons why treatment should be tailored to the individual patient rather than applying a one-size-fits-all approach.
Can You Combine Steroid And Hyaluronic Acid Injections?
Yes.
There are occasions where alternating between steroid injections and hyaluronic acid injections can be an effective long-term strategy.
For example:
Steroid injection → short-term symptom control
Hyaluronic acid injection → longer-term joint support
By alternating treatments, some patients are able to achieve excellent symptom control whilst reducing their overall exposure to corticosteroids.
In my own clinical practice, this approach can be particularly useful for patients who consistently obtain strong short-term relief from steroids but wish to minimise the risks associated with repeated steroid exposure over time.
My Clinical Opinion
If I am treating an older patient with a significant inflammatory flare-up of knee arthritis, a steroid injection can often provide excellent short-term relief.
However, in younger patients or those requiring ongoing treatment over many years, I generally favour hyaluronic acid injections due to their excellent safety profile and potential for longer-lasting symptom relief. Their are also cases where I like to mix the two to achieve maximal results.
Ultimately, the best injection depends on:
Your age
The severity of your arthritis
Your medical history
Previous response to injections
Your long-term treatment goals
A detailed assessment is therefore essential before deciding which treatment is most appropriate.
To discuss your knee arthritis in more detail please contact us today: https://www.elitejointsolutions.com/
References
National Institute for Health and Care Excellence Osteoarthritis Guidelines.
American Academy of Orthopaedic Surgeons Clinical Practice Guidelines for Knee Osteoarthritis.
Osteoarthritis Research Society International Guidance on intra-articular therapies for osteoarthritis.
Bannuru RR et al. Comparative effectiveness of corticosteroid injections versus hyaluronic acid injections for knee osteoarthritis: systematic review and meta-analysis.
Comments