There are a fewinjection options available to help relieve knee pain, including corticosteroids, hyaluronic acid (viscosupplementation), platelet-rich plasma (PRP), dextrose prolotherapy, and saline prolotherapy. Different injections are used depending on the type of knee pain, the cause, and factors such as age and other medications you might also be taking.
While knee injections are generally safe and the risk of complication low, there are some potential side effects you may experience after an injection. It is important to discuss the different knee injection options with your healthcare provider—including the potential side effects—as you consider the most appropriate treatment plan for you.
That said, according to the American Academy of Orthopedic Surgery, evidence supporting the effectiveness of cortisone and PRP are inconclusive, with PRP and stem cells being more recent, and thus with less available evidence about their effectiveness. and viscosupplementation showing strong evidence of not being effective.
Corticosteroids
Corticosteroid injections(cortisone) are often administered for the treatment of knee joint pain and symptoms of osteoarthritis involving the knee.
These injections are used most often to reduce pain and inflammation for people who have:
Common Use
A corticosteroid injection may quickly reduce inflammation in the body, offering knee pain relief that can last for two to three months, and sometimes longer. The temporary pain relief may provide an opportunity to engage in physical therapy, attend an important life event, or postpone knee replacement surgery.
Before receiving a cortisone injection, the area around the injection site will be cleaned. Your healthcare provider may administer a local anesthetic to numb the area for the injection. In some cases, your healthcare provider may use an ultrasound to observe and direct the needle placement. The medication is released directly into the knee at the injection site.
Side Effects
While cortisone injections can be helpful at providing temporary relief, they are not a cure for knee pain and may not work well for everyone. Cortisone injections may cause side effects, particularly when used repeatedly.
Most are minor and go away with time. However, if you are experiencing persistent or increasingly intense side effects, speak with your healthcare provider.
Side effects can include:
High Levels of Exposure
Cortisone—especially when used on a long-term basis—may break down tissues, such as tendons, ligaments, and cartilage in the knee joint.Cartilageacts as a shock absorber, reducing the friction between bones as they move.
For this reason, it is not recommended to get repeated cortisone injections in the same joint over a short period of time, as it may cause more harm than good. If more than one injection is given in the same joint, the injections should be scheduled at appropriate intervals. Patients should not receive more than three to four cortisone injections per year.
Anytime a needle is injected into the skin, there is a chance of infection. An antiseptic will be applied to the skin prior to injection to reduce the risk of infection.
Hyaluronic Acid
Hyaluronic acid injections help improve knee function, and may even slow the progression of the disease.
Brand names of hyaluronic acid injections include:
Before administering the injection, your healthcare provider will sterilize the skin around the injection site. Then, a local anesthetic will be applied (topically or injected) to prevent discomfort during the procedure.
If the knee joint is swollen with excess fluid, your healthcare provider may first withdraw excess fluid to relieve pressure before the injection.
Your healthcare provider will inject the hyaluronic acid into the affected joint. Many patients are advised to place ice on the injection site afterward to reduce pain and swelling.
Common side effects of hyaluronic acid injections include:
Most of these side effects are temporary and go away with time. If your side effects are persistent or progressively worsen, seek medical attention.
Dextrose Prolotherapy and Saline Prolotherapy
Prolotherapyis the injection of an irritant solution into joints to stimulate natural tissue repair. Prolotherapy injections most often use a sugar solution (dextrose) or salt solution (saline) to temporarily:
Healing time varies from person to person, but many people experience relief of painful symptoms within three to four days after the treatment. Because of the healing process, it may take up to a few weeks to experience full relief.
Prolotherapy injections are generally safe and come with few risks. However, the treatment may cause mild side effects, including:
Other Injections
Due to the lack of studies proving safety and efficacy, the American College of Rheumatology and the Arthritis Foundation advise against platelet-rich plasma or stem cell injections.
A Word From Verywell
Before deciding to proceed with having knee injections, you may like to try alternatives to relieve the pain and inflammation in your knee.
These options include:
If you opt for knee injections, it is important to discuss your health history (including allergies) and current medications you are taking with your healthcare provider. This includes over-the-counter medications, herbal remedies, vitamins, and prescription medications.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopedic Surgery.Treatment of osteoarthritis of the knee. 2021.National Health Service.Steroid injections.Park SK, Choi YS, Kim HJ.Hypopigmentation and subcutaneous fat, muscle atrophy after local corticosteroid injection.Korean J Anesthesiol. 2013;65(6 Suppl):S59-61. doi:10.4097/kjae.2013.65.6S.S59McAlindon TE, LaValley MP, Harvey WF, 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;317(19):1967–1975. doi:10.1001/jama.2017.5283Byun SD, Hong YH, Hong SK, et al.Effects of repeated steroid injection at subacromial bursa with different interval.Ann Rehabil Med. 2014;38(6):805-811. doi:10.5535/arm.2014.38.6.805Cleveland Clinic.Sodium hyaluronate intra-articular injection.Tieppo Francio V, Dima RS, Towery C, Davani S.Prolotherapy and low level laser therapy: A synergistic approach to pain management in chronic osteoarthritis.Anesth Pain Med. 2017;7(5):e14470. doi:10.5812/aapm.14470Zhao L, Kaye AD, Abd-Elsayed A.Stem cells for the treatment of knee osteoarthritis: A comprehensive review.Pain Physician. 2018;21(3):229-242.Kolasinski SL, Neogi T, Hochberg MC, et al.2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopedic Surgery.Treatment of osteoarthritis of the knee. 2021.National Health Service.Steroid injections.Park SK, Choi YS, Kim HJ.Hypopigmentation and subcutaneous fat, muscle atrophy after local corticosteroid injection.Korean J Anesthesiol. 2013;65(6 Suppl):S59-61. doi:10.4097/kjae.2013.65.6S.S59McAlindon TE, LaValley MP, Harvey WF, 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;317(19):1967–1975. doi:10.1001/jama.2017.5283Byun SD, Hong YH, Hong SK, et al.Effects of repeated steroid injection at subacromial bursa with different interval.Ann Rehabil Med. 2014;38(6):805-811. doi:10.5535/arm.2014.38.6.805Cleveland Clinic.Sodium hyaluronate intra-articular injection.Tieppo Francio V, Dima RS, Towery C, Davani S.Prolotherapy and low level laser therapy: A synergistic approach to pain management in chronic osteoarthritis.Anesth Pain Med. 2017;7(5):e14470. doi:10.5812/aapm.14470Zhao L, Kaye AD, Abd-Elsayed A.Stem cells for the treatment of knee osteoarthritis: A comprehensive review.Pain Physician. 2018;21(3):229-242.Kolasinski SL, Neogi T, Hochberg MC, et al.2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Orthopedic Surgery.Treatment of osteoarthritis of the knee. 2021.National Health Service.Steroid injections.Park SK, Choi YS, Kim HJ.Hypopigmentation and subcutaneous fat, muscle atrophy after local corticosteroid injection.Korean J Anesthesiol. 2013;65(6 Suppl):S59-61. doi:10.4097/kjae.2013.65.6S.S59McAlindon TE, LaValley MP, Harvey WF, 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;317(19):1967–1975. doi:10.1001/jama.2017.5283Byun SD, Hong YH, Hong SK, et al.Effects of repeated steroid injection at subacromial bursa with different interval.Ann Rehabil Med. 2014;38(6):805-811. doi:10.5535/arm.2014.38.6.805Cleveland Clinic.Sodium hyaluronate intra-articular injection.Tieppo Francio V, Dima RS, Towery C, Davani S.Prolotherapy and low level laser therapy: A synergistic approach to pain management in chronic osteoarthritis.Anesth Pain Med. 2017;7(5):e14470. doi:10.5812/aapm.14470Zhao L, Kaye AD, Abd-Elsayed A.Stem cells for the treatment of knee osteoarthritis: A comprehensive review.Pain Physician. 2018;21(3):229-242.Kolasinski SL, Neogi T, Hochberg MC, et al.2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131
American Academy of Orthopedic Surgery.Treatment of osteoarthritis of the knee. 2021.
National Health Service.Steroid injections.
Park SK, Choi YS, Kim HJ.Hypopigmentation and subcutaneous fat, muscle atrophy after local corticosteroid injection.Korean J Anesthesiol. 2013;65(6 Suppl):S59-61. doi:10.4097/kjae.2013.65.6S.S59
McAlindon TE, LaValley MP, Harvey WF, 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;317(19):1967–1975. doi:10.1001/jama.2017.5283
Byun SD, Hong YH, Hong SK, et al.Effects of repeated steroid injection at subacromial bursa with different interval.Ann Rehabil Med. 2014;38(6):805-811. doi:10.5535/arm.2014.38.6.805
Cleveland Clinic.Sodium hyaluronate intra-articular injection.
Tieppo Francio V, Dima RS, Towery C, Davani S.Prolotherapy and low level laser therapy: A synergistic approach to pain management in chronic osteoarthritis.Anesth Pain Med. 2017;7(5):e14470. doi:10.5812/aapm.14470
Zhao L, Kaye AD, Abd-Elsayed A.Stem cells for the treatment of knee osteoarthritis: A comprehensive review.Pain Physician. 2018;21(3):229-242.
Kolasinski SL, Neogi T, Hochberg MC, et al.2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131
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