Injection-Based Therapies for the Management of Hip and Knee Osteoarthritis.

J Bone Joint Surg Am · Nov 05 2025 · Review

Seah KTM, Neufeld ME, Howard LC, Garbuz DS, Masri BA

Department of Orthopaedics, University of British Columbia, Vancouver, Canada

General Orthopaedics Adult Reconstruction

SUMMARY — THE REDUCTIONThis review finds corticosteroid injections are safe but short-lived, hyaluronic acid should not be routine, biologic injections lack sufficient evidence, and even saline injections can improve pain/function—guiding more judicious use of injectables for hip/knee OA.
Abstract, as published

➢ Corticosteroid injections are largely safe, but patients and practitioners should be aware of the small risk of adverse side effects, and their limited duration of efficacy. The timing of injection should be coordinated with potential surgical dates.➢ The routine use of hyaluronic acid injections for osteoarthritis is not recommended, but there are certain subsets of patients, such as those who have undergone other therapies that failed, who may benefit from it.➢ Local anesthetics are frequently used in conjunction with corticosteroids for enhanced pain control; however, caution is needed because of concerns regarding chondrotoxicity. Proper patient selection is crucial, and their overuse for diagnostic purposes is not recommended.➢ There is currently insufficient evidence to support the routine use of prolotherapy, bone marrow aspirate concentrate, stromal vascular fraction, and mesenchymal stromal cell injections.➢ Intra-articular saline solution has been associated with improvements in both patient-reported pain and function scores, and this should be considered in future study designs.

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