Which choices may help your sore joint?

Which choices may bring shorter relief?

Steroid medicine put into the joint may ease soreness sooner than some choices, though relief may not last. Another knee option is a hyaluronic acid gel shot. It adds one part of the fluid normally found in a joint. Large studies found such a small average change in pain that many people wouldn’t feel it. Your doctor can explain whether either option fits your medicines and health. Heat, cold and rest between chores may still help.

You’ll want to ask how long relief may last.

What are PRP and bone marrow concentrate?

PRP means platelet-rich plasma; the clinic takes some of your blood and spins it to collect platelets, while bone marrow concentrate uses marrow removed at the pelvis and spun for treatment. Both are regenerative treatments, which means the prepared blood or marrow goes into your aching joint. Results are mixed, and a knee study can’t say what your hip or shoulder will do. This care is discussed for soreness and joint use; it isn’t a promise of new tissue.

Your exam comes before the choice.

When might surgery be discussed?

Surgery may be discussed when there’s a great deal of wear and ordinary days feel very limited. A blood or marrow treatment isn’t a reason to dismiss an operation your doctor believes is needed. You can ask how waiting affects the joint, what recovery involves and which knee or hip surgery alternatives still fit. Until then, choose enough activity to stay loose without leaving the joint sharply worse.

You’re allowed time for questions.

Sources

1. A Bayesian network meta-analysis of 48 Level I-II randomized trials (9,338 knees) with a minimum 6-month follow-up ranked the four commonest intra-articular injections. HA and PRP both significantly improved pain versus placebo; HA, PRP and BMAC all significantly improved function versus placebo. SUCRA rankings were PRP 91.54, BMAC 76.46, HA 53.12, corticosteroid 15.18 and placebo 13.70 - corticosteroid ranked barely above placebo at six months and beyond.

   Jawanda H, et al. — Platelet-Rich Plasma, Bone Marrow Aspirate Concentrate, and Hyaluronic Acid Injections Outperform Corticosteroids in Pain and Function Scores at a Minimum of 6 Months as Intra-Articular Injections for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis.. Arthroscopy, 2024. DOI: 10.1016/j.arthro.2024.01.037.

2. The largest head-to-head trial of cell-based orthobiologics to date randomised 480 patients with KL II-IV knee OA across four arms: autologous bone marrow aspirate concentrate, autologous adipose stromal vascular fraction, allogeneic umbilical cord tissue-derived MSCs, and a corticosteroid injection control. At 12 months NONE of the three orthobiologic injections was superior to another or to the corticosteroid control on either co-primary endpoint (VAS pain, KOOS pain), and none of the four groups showed a significant change in MRI osteoarthritis score from baseline. No procedure-related serious adverse events were reported.

   Mautner K, et al. — Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial.. Nature Medicine, 2023. DOI: 10.1038/s41591-023-02632-w.

3. RESTORE, the largest and most rigorously blinded placebo-controlled PRP trial in knee OA (n=288, participant-, injector- and assessor-blinded), gave three weekly injections of a commercial leukocyte-poor PRP or saline. At 12 months the change in knee pain was -2.1 vs -1.8 points (difference -0.4; 95% CI -0.9 to 0.2; P=.17) and the change in medial tibial cartilage volume was -1.4% vs -1.2% (difference -0.2%; P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no between-group difference. The authors concluded the findings do not support the use of PRP for knee OA.

   Bennell KL, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

4. The ADIPOA2 phase 2b trial randomised 135 patients with mild-to-moderate knee OA to low-dose (2 million) or high-dose (10 million) culture-expanded autologous adipose-derived stromal cells or saline placebo. At 6 months 47.3% of ADSC patients were OARSI/OMERACT strict responders versus 54.8% on placebo (relative risk 0.86; P=.46), and no secondary outcome differed significantly. A single injection of expanded adipose stromal cells did NOT improve pain or function versus saline.

   Pers YM, et al. — Effect of intra-articular adipose-derived mesenchymal stromal cell versus placebo injection on pain and function in patients with knee osteoarthritis: the ADIPOA2 phase 2b randomised clinical trial.. Annals of the Rheumatic Diseases, 2025. DOI: 10.1016/j.ard.2025.07.026.

5. A network meta-analysis of 11 RCTs (1,353 patients) with HIP osteoarthritis found that at 2-4 and 6 months NO intervention - corticosteroid, hyaluronic acid or PRP - significantly outperformed intra-articular saline placebo for either pain or function, while all interventions including placebo produced improvement exceeding the minimal clinically important difference from baseline. Evidence from the knee does not transfer to the hip.

   Gazendam A, et al. — Intra-articular saline injection is as effective as corticosteroids, platelet-rich plasma and hyaluronic acid for hip osteoarthritis pain: a systematic review and network meta-analysis of randomised controlled trials.. British Journal of Sports Medicine, 2021. DOI: 10.1136/bjsports-2020-102179.

6. The ESSKA-ORBIT European consensus on blood-derived orthobiologics graded 28 question-statement sets; only 9 of 28 had high-level scientific support. Three statements reached grade A: that there is enough preclinical and clinical evidence to support PRP use in knee OA; that clinical evidence shows effectiveness in MILD TO MODERATE knee OA (KL grade 3 or lower); and that PRP provides a longer effect than the short-term effect of corticosteroid with a safer profile. The panel regarded PRP as a valid and possible first-line injectable option for KL grades 1-3.

   Laver L, et al. — The use of injectable orthobiologics for knee osteoarthritis: A European ESSKA-ORBIT consensus. Part 1-Blood-derived products (platelet-rich plasma).. Knee Surgery, Sports Traumatology, Arthroscopy, 2024. DOI: 10.1002/ksa.12077.

7. FDA states verbatim of stem cell products, stromal vascular fraction (adipose-derived cells), umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products: 'None of these products have been approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.