Samuel G Oltman, ND, RMSK
Knee osteoarthritis is the most common cause of knee pain. Most patients that seek treatment have been offered a cortisone injection because they’re told “it helps arthritis”. This is incorrect on multiple levels and most people aren’t even told of better options like Platelet Rich Plasma (PRP). PRP is an innovative treatment using your body’s own healing power to alleviate the pain of knee osteoarthritis over the long term.
In a recent NY Times article on preventing knee osteoarthritis, the author outlines many helpful strategies and explains the cause clearly. However, as is common when doctors discuss cortisone with patients too, cortisone injections are mentioned as a pain relief tool without mentioning the important caveat: On average, cortisone injections make osteoarthritis worse and accelerate the progression to knee replacement.
Does Cortisone Help At All?
What’s more, there is evidence that cortisone injections may not even be better than placebo (saline) injections beyond 3 months. In a meta-analysis of 14 trials, cortisone injections were found to be no better than placebo and in one of the RCTs, made the cartilage worse in a dose dependent manner. One cortisone injection will likely not make osteoarthritis worse, but as the total dose increases the joint health decreases. In my opinion, the use of cortisone for knee osteoarthritis should be made based on the patient’s short vs long term goals (explained here). But it is rarely presented in this manner and the patient pays the price.
PRP vs Cortisone For Knee Osteoarthritis
PRP as an alternative to cortisone has been well-studied. Those who say it hasn’t or “there isn’t any science” simply aren’t reading the scientific literature. In head-to-head studies, PRP consistently outperforms cortisone in pain relief scores at 3, 6, 9, and 12 month follow ups. The subtext is that cortisone tends to provide more pain relief at the 1 month mark post-injection, then regresses toward the placebo results. In another study, PRP demonstrated pain relief effects up to 24 months after the last treatment.
Many studies look at a single cortisone injection vs a single PRP injection. While there is more debate over this, a series of PRP injections has been shown to be the best for long term pain relief. This is why at Cascade Regenerative Medicine we counsel our patients on getting the best results with a series of 3 PRP injections, spaced out by 3-4 weeks.
Optimal Knee Health
Low-impact exercise, leg strength, healthy body weight, and a whole-foods diet are all important factors in maintaining knee health and reducing pain. Beyond this, addressing structural (cartilage) and chemical (inflammation) factors is needed. When you are told by another doctor that “cortisone injections help arthritis”, know that the correct, evidence-based statement is: Cortisone injections help the pain of osteoarthritis in the short term while making the joint health worse in the long run.
PRP is an innovative treatment using your body’s own healing power to alleviate the pain of knee osteoarthritis over the long term. The evidence shows that PRP is superior to cortisone for knee pain relief. Seek the expertise at Cascade Regenerative Medicine to see if you are a good candidate for improving your knee osteoarthritis naturally.
Ayub S, Kaur J, Hui M, et al. Efficacy and safety of multiple intra-articular corticosteroid injections for osteoarthritis-a systematic review and meta-analysis of randomized controlled trials and observational studies. Rheumatology (Oxford). 2021;60(4):1629-1639.
McLarnon M, Heron N. Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2021;22(1):550.
Donovan RL, Edwards TA, Judge A, Blom AW, Kunutsor SK, Whitehouse MR. Effects of recurrent intra-articular corticosteroid injections for osteoarthritis at 3 months and beyond: a systematic review and meta-analysis in comparison to other injectables. Osteoarthritis Cartilage. 2022;30(12):1658-1669.