Steroid Injections vs. Hyaluronic Acid Injections for OA

Dec 31, 2012
misc image
How do Steroid Injections differ from Hyaluronic Acid Injections?

How do Steroid Injections differ from Hyaluronic Acid Injections?

Steroid Injections vs. Hyaluronic Acid Injections for OA

When Osteoarthritis of the knee sets in the pain that comes with it can be devastating. Dramatically affecting all areas of your life, preventing you from loved hobbies such as playing sports, to making the smallest of everyday tasks like getting out of bed a huge and painful hassle.

At first, simple over-the-counter pain medications like Tylenol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen seem like a good option to relieve your osteoarthritis symptoms. However, as the dosage is increased so are the health risks caused by these drugs for instance gastrointestinal ulcers, high blood pressure, kidney damage, heart problems, and even stroke.

Because of these risks as well as erratic efficacy from OTC drugs, people have been turning to injections of either Steroids (Cortisone) or Hyaluronic Acid to decrease pain. Both are shots patients receive directly in the knee joint, but they provide different results.

Hyaluronic Acid (HA)

HA is a naturally occurring polymer found in every tissue of our body. It is particularly concentrated in the skin and in synovial fluid but as we age it decreases. For our skin cells, HA is vital for accurate cell-to-cell communication, hydration, and nutrient distribution. For joints HA supports healthy lubrication and shock absorption. Studies indicate that HA moderates prostaglandin production which provides additional support for joint function and comfort.


HA injections are an effective and safe approach to combating Osteoarthritis of the knee for extended periods of time. When either cortisone or HA is injected into a knee cortisone was found to be more effective for Osteoarthritis pain than HA during weeks 1-4. By week 4, the two were equally effective. For long term pain relief after week 8, Hyaluronic Acid is more effective than cortisone, according to a 2009 Tufts University analysis of seven trials involving 606 participants.

Steroid Injections vs. Hyaluronic Acid Injections for OA

 Graphic represents results from Cortisone Injection in knee.

Side Effects

There can also be some adverse side effects with cortisone injections. The most common side effect is called a ‘cortisone flare’; this is where the cortisone crystallizes in the joint, briefly causing more pain than originally present. Also, unlike Hyaluronic Acid, cortisone injections can weaken ligaments and tendons which can contribute to increased knee degradation over time. For this reason doctors usually allow no more than three injections of cortisone a year.

Here at the Reflex clinic we utilize Hyaluronic Acid injections, as part of our treatment plan. HA was first approved by the Food and Drug Administration for Osteoarthritis treatment in 1997. Depending on the severity of the Osteoarthritis, treatment results can last anywhere from two months to a year and can be repeated without adverse side effects.


The injections we administer not only help relieve pain and stiffness, they also allow some patients to postpone joint-replacement surgery indefinitely. Injecting HA directly into the knee joint improves cushioning and tends to boost the body’s natural production of HA, achieving reduced inflammation and depleted pain, ultimately resulting in the prospect for increased mobility and better quality of life.