Cortisone vs. Hyaluronic Acid: Which Joint Injection Is Better for Your Knee?

When knee pain becomes a problem, joint injections are an option many consider. But what exactly should be injected? Two of the most common options are cortisone and hyaluronic acid. Both aim to relieve pain and improve mobility, but they work in different ways and have different risk and benefit profiles. In this article, we will explore each in depth to help you understand which might be best for your knee.

Key Points

• Cortisone is a powerful anti-inflammatory that can offer rapid pain relief, but its use should be limited due to possible side effects and a lack of solid evidence in some studies.

• Hyaluronic acid, also known as viscosupplementation, aims to improve joint lubrication, although its overall effectiveness is debated and may not be as consistent as expected.

• Studies suggest that neither cortisone nor hyaluronic acid are miracle cures and that their effectiveness can vary significantly among individuals.

• The choice between cortisone and hyaluronic acid should be based on an individualized assessment, considering the severity of osteoarthritis, the patient's specific symptoms, and their expectations.

• Current research questions the long-term effectiveness of both injections and suggests that approaches such as exercise and weight loss might be more beneficial in many cases.

Understanding Joint Injections

Definition and Purpose of Joint Injections

A joint injection, also known as an intra-articular injection, is a medical procedure in which a substance is introduced directly into a joint. The main goal is to relieve pain and inflammation, thereby improving the patient's mobility and quality of life.

Mechanisms of Action of Intra-articular Treatments

Intra-articular treatments act in various ways depending on the substance injected. Some aim to reduce inflammation, while others intend to lubricate the joint or stimulate tissue repair.

• Inflammation reduction: Certain medications decrease the inflammatory response in the joint.

• Lubrication and cushioning: Other substances mimic natural synovial fluid, improving gliding and reducing friction.

• Healing stimulation: Some therapies aim to promote the regeneration of damaged tissues.

Common Indications for Joint Injections

Joint injections are commonly recommended to treat various conditions affecting the joints, especially the knee. The most frequent indications include:

• Symptomatic osteoarthritis.

• Inflammatory arthritis such as rheumatoid arthritis.

• Bursitis and tendinitis.

• Chronic joint pain without a clear cause.

It is important that the decision on which type of injection is most suitable for your case is made by a qualified medical professional, such as Dr. Santiago Manzanal, after an individualized evaluation.

Cortisone: An Anti-inflammatory Agent

Cortisone, or more precisely corticosteroids, has long been a popular option for knee pain relief. Its main function is to act as a powerful anti-inflammatory agent.

Mechanism of Action of Corticosteroids

Corticosteroids are a class of medications that mimic steroid hormones produced by the adrenal glands. When injected directly into the knee joint, they act by suppressing the inflammatory response. They reduce the production of chemicals that cause inflammation, such as prostaglandins and leukotrienes. This can lead to a significant decrease in swelling, redness, and, most importantly for the patient, pain.

Efficacy and Duration of Pain Relief with Cortisone

Cortisone can offer rapid pain relief, especially in cases where inflammation is a significant component of the symptoms. Many patients experience noticeable improvement within days. However, the duration of this relief is usually limited, generally lasting from a few weeks to a few months. Studies indicate that the benefits typically last several weeks but are not effective long-term.

Possible Side Effects and Limitations of Cortisone

While cortisone can be effective for short-term relief, it is not without drawbacks. Repeated or excessive use can have detrimental effects on articular cartilage. Some research suggests that corticosteroids can negatively affect protein synthesis and cartilage matrix, alter the shape of cartilage cells, and inhibit new cartilage growth. Additionally, there are potential systemic side effects, such as temporary increases in blood glucose levels and a possible decrease in immune function. An increased risk of postoperative infection has also been observed in patients receiving corticosteroid injections in the perioperative period of knee arthroscopy.

It is important to understand that while cortisone can reduce inflammation and pain in the short term, its impact on the long-term health of cartilage and the joint is an area of considerable debate and concern in the medical community.

While cortisone can be a useful tool in certain circumstances, it is crucial to discuss the risks and benefits with a healthcare professional. Dr. Santiago Manzanal can help you evaluate whether this treatment is suitable for your particular situation.

Hyaluronic Acid: Viscosupplementation for the Knee

The Role of Hyaluronic Acid in the Joint

Hyaluronic acid is a substance found naturally in our body, especially in the synovial fluid of joints. This fluid acts as a lubricant and shock absorber, allowing bones to glide smoothly against each other and absorbing daily impact. In knees with osteoarthritis, the quantity or quality of this hyaluronic acid can be reduced, contributing to pain and stiffness.

Viscosupplementation, as this treatment is known, involves injecting hyaluronic acid directly into the knee joint. The goal is to replenish or supplement the synovial fluid, aiming to restore lubrication and cushioning capacity. Some people refer to these injections by names such as "rooster comb injections" or by specific commercial brands.

While hyaluronic acid can offer temporary relief, it is important to understand that it does not reverse the osteoarthritis process or regenerate cartilage.

Scientific Evidence on the Effectiveness of Hyaluronic Acid

Scientific evidence on the effectiveness of hyaluronic acid presents mixed results. Some studies suggest it can be useful for relieving pain and improving knee function in certain patients, especially in early or moderate stages of osteoarthritis. However, other studies indicate that its benefit is limited and not always superior to a placebo.

• Pain relief: Can provide short-term relief for some patients.

• Improved function: Some users report an improvement in mobility.

• Does not regenerate cartilage: Does not have the ability to repair existing joint damage.

Research continues to more precisely determine in which patients and at what stages of the disease this treatment offers the best results. It is a topic that still generates debate among specialists.

Comparison of Results with Hyaluronic Acid

The results of viscosupplementation can vary considerably from person to person. While some patients experience a noticeable improvement in their symptoms, others may not notice any significant change. It is common for the effect, when present, to be temporary, and not a long-term solution.

• Duration of effect: Generally, relief can last from a few months to a year, although this is not guaranteed.

• Number of injections: Some treatment regimens involve a single injection, while others require a series of several injections over weeks. Recent studies suggest that a single injection could be as effective as a cycle of several.

• Expectations: It is important to have realistic expectations; this treatment is considered more a measure to postpone or delay the need for knee replacement surgery, rather than a cure.

For a personalized evaluation and to discuss whether hyaluronic acid is a suitable option for your case, you can consult with Dr. Santiago Manzanal. He can guide you on available alternatives, including procedures such as knee arthroscopy if necessary.

Direct Comparison: Cortisone vs. Hyaluronic Acid

When deciding on an injection for knee pain, cortisone and hyaluronic acid are two common options. Each has a distinct approach and results that are important to understand.

Short- and Long-Term Efficacy of Each Treatment

Cortisone is known for its rapid anti-inflammatory action. Many people experience noticeable pain relief within days after the injection. However, this relief tends to be temporary, lasting from a few weeks to a few months. It is not a long-term solution, and its repeated use can have drawbacks.

On the other hand, hyaluronic acid, also called viscosupplementation, aims to improve joint lubrication and cushioning. Its effect may take a little longer to be noticed, sometimes several weeks, but some studies suggest it can offer more sustained relief over time for certain patients. However, the evidence on its overall efficacy is mixed, and some specialists do not routinely recommend it.

Comparative Risks and Benefits

Cortisone offers rapid pain relief, but its continued use can have adverse effects.

• Benefits of Cortisone: Rapid reduction of inflammation and pain.

• Risks of Cortisone: Possible cartilage damage with frequent injections, increased risk of infection, and local side effects such as temporary pain or swelling.

• Benefits of Hyaluronic Acid: Improved joint lubrication, potential for more lasting relief in some cases.

• Risks of Hyaluronic Acid: Fewer serious side effects than cortisone, although there may be post-injection pain or swelling. Its effectiveness can vary significantly among individuals.

It is essential to discuss with your doctor, such as Dr. Santiago Manzanal, the specific benefits and risks of each treatment in your particular situation.

Considerations on Osteoarthritis Progression

Recent research suggests that repeated corticosteroid injections might be associated with greater osteoarthritis progression compared to hyaluronic acid or the absence of injections. Studies using advanced imaging such as magnetic resonance imaging (MRI) have observed a worsening of subchondral bone and cartilage lesions in patients who received cortisone recurrently. In contrast, hyaluronic acid has shown in some analyses an association with less progression of these lesions.

This information underscores the importance of using cortisone in moderation and only when strictly necessary, following medical recommendations to avoid potential long-term damage to the joint.

Factors to Consider When Choosing Joint Injections

The decision on which type of injection is most suitable for your knee is not one-size-fits-all. It requires a careful evaluation of several elements to ensure that the chosen treatment aligns with your specific needs and health goals.

Individualized Patient Evaluation

Every person is different, and what works for one may not be ideal for another. It is important to consider your complete medical history, including any pre-existing conditions, allergies, or previous treatments you have received. Dr. Santiago Manzanal focuses on understanding your particular situation to recommend the best option. His knowledge of different therapies allows him to offer a personalized plan.

Severity of Osteoarthritis and Symptoms

The stage of osteoarthritis and the intensity of your symptoms play an important role. For rapid relief of inflammation and acute pain, cortisone may be an option. However, if the goal is to improve joint lubrication and viscoelasticity in the long term, hyaluronic acid might be more beneficial. The choice will depend on whether we are looking for a more immediate solution or a more sustained effect on joint health.

Patient Expectations and Treatment Goals

It is essential to have realistic expectations about the results of any injection. Are you looking for rapid relief to perform specific activities, or are you interested in an approach that can modify the long-term progression of the disease? Openly discussing your goals with Dr. Santiago Manzanal will help you select the treatment that best fits your expectations. Sometimes, the best strategy involves exploring conservative treatments before considering more invasive options, such as seeking a second opinion for joint replacement seeking a second opinion for joint replacement.

• Duration of relief: Do you need immediate relief or a more prolonged effect?

• Frequency of injections: How many injections are considered safe per year?

• Impact on cartilage: Is there any concern about the long-term effect on articular cartilage?

The choice between cortisone and hyaluronic acid should be based on a clear understanding of the benefits and limitations of each, always in consultation with a medical professional. The goal is to optimize your knee function and improve your quality of life.

Current Research and Future Perspectives

The field of knee joint injections is constantly evolving. Current research focuses on refining the understanding of how these treatments work and identifying best practices for their application.

Comparative Studies and Systematic Reviews

Comparative studies and systematic reviews are fundamental for evaluating the real effectiveness of cortisone and hyaluronic acid injections. While some initial studies showed promising results for hyaluronic acid, more recent research and large-scale data analyses, such as those using Medicare information, have raised doubts about its clinical value compared to placebo. On the other hand, cortisone remains a cornerstone for rapid inflammation relief, although current research also explores its possible long-term effects on osteoarthritis progression.

An analysis published in Arthritis & Rheumatology in March 2022 examined the effects of intra-articular corticosteroid injections in knees with osteoarthritis over a 5-year follow-up. The findings suggested that, compared to untreated knees, those that received intra-articular corticosteroid injections had a similar risk of needing total knee replacement or worsening osteoarthritis. It is important to interpret these results with caution and await replication in other cohorts.

New Approaches and Emerging Therapies

Beyond cortisone and hyaluronic acid, research is actively exploring new options. Biological therapies, such as platelet-rich plasma (PRP) and stem cells, are being studied, which aim to stimulate cartilage repair and reduce inflammation more naturally. The combination of treatments, such as the use of knee braces along with injections, is also being investigated to optimize results.

Regenerative medicine and combined therapies represent the next frontier in knee osteoarthritis management, seeking not only to relieve pain but also to promote healing and regeneration of joint tissue.

The Evolution of Medical Recommendations

Medical recommendations adapt as new evidence emerges. The current trend is towards more personalized medicine, where the choice of injection is based on a detailed evaluation of the patient, the severity of their condition, and their treatment goals. For those seeking comprehensive and updated management of their knee pain, consulting with specialists like Dr. Santiago Manzanal can offer a clear perspective on the most suitable and evidence-based options.

• Individualized evaluation: Consider the patient's complete medical history.

• Scientific evidence: Base decisions on the most recent and rigorous studies.

• Multimodal approach: Explore combinations of treatments for better results.

In this section, we explore what is happening right now in the field of orthopedics and what we can expect in the future. We want you to be part of this advancement. Visit our website to discover more about the latest treatments and how they can help you.

Conclusion: Cortisone or Hyaluronic Acid for your knee?

Ultimately, the choice between cortisone and hyaluronic acid for knee pain is not straightforward. Cortisone can offer rapid inflammation relief, but its use should be limited due to possible side effects and a lack of solid evidence in some studies. On the other hand, hyaluronic acid, although sometimes criticized for its variable effectiveness, could offer longer-term benefits for some people and is considered a safer option for repeated use. It is important to remember that neither of these injections is a miracle cure; often, a combined approach including exercise and weight management may be most beneficial. Talk to your doctor to determine which option best aligns with your particular situation and health goals.

Frequently Asked Questions

What is a joint injection and what is it for?

A joint injection is like putting medicine directly into the knee joint. Its main purpose is to relieve pain and inflammation caused by arthritis, helping you move better.

How does cortisone work in the knee?

Cortisone is a very strong medication that reduces swelling and pain in the knee. It works well to relieve discomfort, but its effect can last from a few days to several months.

What is hyaluronic acid and how does it help the knee?

Hyaluronic acid is a substance found naturally in our joints and acts as a lubricant and shock absorber. Hyaluronic acid injections aim to replenish this fluid to protect the knee and facilitate movement.

What is the main difference between cortisone and hyaluronic acid?

Cortisone is a powerful anti-inflammatory that offers rapid relief, but its frequent use can have limitations. Hyaluronic acid aims to improve joint lubrication, and although some studies suggest it can help delay the need for surgery, its effectiveness varies and is not always as rapid as cortisone.

What are the possible side effects of these injections?

After any injection, it's common to feel a little pain or swelling in the area for one or two days. There's also a very low risk of problems like tendon or nerve damage, bleeding, or infection. That's why doctors usually limit the number of injections given per year.

Which injection is best for my knee?

The best option depends on each person. Your doctor will evaluate the severity of your arthritis, your symptoms, and what you expect from the treatment to decide whether cortisone or hyaluronic acid is more suitable for you.