Introduction
Joint pain, especially in the knees and hips, affects many adults and their carers who are eager to understand effective treatment options. Among the less invasive methods are injections, which can provide relief and improve mobility. Two popular types are hyaluronic acid (HA) injections—sometimes called gel or viscosupplementation injections—and cortisone (steroid) injections. Each serves a different purpose and has its own advantages and considerations. This article offers a straightforward and balanced comparison of these options, looking at how they work, when they are recommended, their effectiveness, possible risks, and guidance to help you make an informed choice.

Understanding the Mechanisms: How Hyaluronic Acid and Cortisone Injections Work

Hyaluronic acid injections work by topping up the natural fluid that lubricates and cushions your joints, known as synovial fluid. When osteoarthritis develops, this fluid thins or loses its effectiveness, causing stiffness and discomfort. By replenishing it, HA injections help bones move smoothly and can reduce pain gradually over time. Research has shown that hyaluronic acid’s "mechanical, viscoelastic, and antinociceptive properties" support its use alongside cortisone, enhancing symptom relief. Interestingly, HA also finds uses beyond joint care—for example, it’s recognised as "a highly effective and viable alternative" for softening fine lines in cosmetic treatments, showing how versatile this substance is.

In contrast, cortisone injections work by quickly calming inflammation within the joint, which is often the main cause of pain and swelling during flare-ups. This fast-acting effect can ease discomfort and improve movement in the short term, though usually the relief doesn’t last as long as with hyaluronic acid.

In simple terms: cortisone acts like a fire extinguisher, cooling inflammation rapidly, while hyaluronic acid acts more like an oil change, helping the joint work better and last longer. Orthopaedic expert Professor Paul Lee uses these analogies to help patients understand the key differences and what might suit their condition best.

Indications and Patient Selection

Choosing between cortisone and hyaluronic acid injections depends largely on individual circumstances. Cortisone injections are generally recommended for those experiencing sudden inflammation and intense pain flare-ups. They provide swift symptom control, which can be crucial for regaining mobility or managing severe episodes.

Conversely, hyaluronic acid injections are better suited for people with mild to moderate osteoarthritis, where joint stiffness and chronic discomfort are more prominent than inflammation. HA aims to restore cushioning and lubrication, which may help slow joint wear and maintain better function over time.

Experts stress that the decision shouldn’t be one-size-fits-all. Factors like the stage of osteoarthritis, patient age, activity levels, and overall health must all be taken into account. At MSK Doctors, thorough assessments ensure patients receive personalised advice, helping them choose the treatment option most likely to benefit their unique situation.

Efficacy and Duration of Relief: What Patients Can Expect

Cortisone injections often bring fast relief within days, making them excellent for controlling acute pain. However, this relief usually lasts a few weeks to a few months before symptoms may return. While cortisone is excellent at quelling inflammation, it doesn’t typically improve the overall condition of the joint in the longer term.

Hyaluronic acid injections tend to take longer to show effects—perhaps several weeks—but their benefits often last much longer, typically six months to a year. The reason is that HA helps restore joint lubrication and cushioning, allowing for smoother, less painful movement. In one study focusing on hand conditions, "fourteen patients (93.3%)... had complete symptom resolution at 6 months, which persisted for 12 months in 11 patients (73.3%)" after receiving corticosteroid and hyaluronic acid injections. Another study highlights that HA injection “provides immediate and occasionally long-lasting relief from symptoms” in diverse clinical settings.

It's important to bear in mind that cortisone injections are best used sparingly, as frequent use can thin the cartilage. Hyaluronic acid injections are generally safer for repeated administration, although timing and individual responses vary. Professor Lee reminds patients that while these injections can ease symptoms, they are not cures for osteoarthritis, and results differ from person to person.

Risks, Side Effects, and Practical Considerations

Both injection types are generally safe when given by skilled healthcare professionals, though they have different side effect profiles.

Cortisone injections may cause a brief flare-up of pain after administration and, if used often, carry risks such as thinning of cartilage or effects like raised blood sugar, especially important for those with diabetes.

Hyaluronic acid injections tend to cause fewer systemic side effects. Most patients experience only mild, temporary discomfort or swelling around the injection site. Since HA is naturally present in joints, the likelihood of serious adverse reactions is low. Supporting this, research has found "no patients… reported major or minor complications during or after corticosteroid injection, or required a compression bandage," underscoring the safety of properly administered injections.

Whenever considering injections, it’s crucial to discuss the potential benefits and risks with an orthopaedic specialist. MSK Doctors prioritise patient safety and ensure treatments fit within a wider, thoughtful care plan.

FAQs: Common Questions About Joint Pain Injection Options

1. How soon can I expect pain relief after a cortisone injection?
Pain usually eases within a few days and can last from several weeks to a few months, depending on individual response.

2. Are hyaluronic acid injections suitable for advanced osteoarthritis?
They are typically more effective in mild to moderate cases. In advanced osteoarthritis, benefits may be limited, and other treatments might be recommended.

3. Can I have both cortisone and hyaluronic acid injections?
Yes, but usually not at the same time. Doctors will space treatments to reduce side effects and optimise benefits.

4. Are there any risks with repeated cortisone injections?
Repeated use may risk cartilage damage and other side effects, so doctors generally limit how frequently you can have cortisone shots.

Conclusion and Responsible Recommendation

In summary, cortisone and hyaluronic acid injections offer distinct but complementary ways to manage joint pain from osteoarthritis. Cortisone is best for quickly easing inflammation and its related pain, while hyaluronic acid can provide longer-lasting improvement by enhancing joint lubrication and function.

Choosing the right injection should always follow a thorough evaluation by qualified professionals who consider your specific condition, symptoms, and goals. Professor Paul Lee and the MSK Doctors team are committed to delivering expert guidance to help you make the safest, most effective choice.

For personalised medical advice, please consult a qualified healthcare professional.

References

Callegari, L., Spanò, E., Bini, A., Valli, F., Genovese, E. A., & Fugazzola, C. (2011). Ultrasound-Guided Injection of a Corticosteroid and Hyaluronic Acid. Drugs in R&D, 11(2), 137–145. https://doi.org/10.1007/bf03259803
Twomey, K., Lehn, B., & Vasani, S. (2018). Management of leaking tracheoesophageal puncture with hyaluronic acid injection. Head & Neck, 40(7), 1573–1576. https://doi.org/10.1002/hed.25162
Fagien, S., & Cassuto, D. (2012). Reconstituted Injectable Hyaluronic Acid. Plastic & Reconstructive Surgery, 130(1), 208–217. https://doi.org/10.1097/prs.0b013e318254b3f6