Knee injections for osteoarthritis: corticosteroid and hyaluronic acid

Written by Dr Sean Leo, a consultant orthopaedic surgeon whose clinical focus is the knee, sports injuries and the lower limb.

Last updated: 9 October 2026.

Corticosteroid injections can give short-term relief from knee osteoarthritis pain, typically lasting weeks ^[1][2]. Guidelines disagree about hyaluronic acid injections, and the decision is individual ^[1][3][4]. Injections sit alongside the core treatments of education, exercise and weight management ^[4].

An injection decision is made at an assessment, with your own knee, history and goals in view.

What are knee injections for osteoarthritis?

An intra-articular injection goes into the joint itself. This page covers corticosteroid injections and hyaluronic acid injections for knee osteoarthritis (OA).

• OA is a disease of the whole joint, and it has several risk factors ^[1].
• Core treatments for knee OA in the 2019 OARSI guideline include structured land-based exercise programs, with or without dietary weight management, and mind-body exercise such as Tai Chi or yoga, and the guideline treats education about osteoarthritis as a standard of care ^[4].
• Other ways to ease arthritis pain are in how to manage arthritis pain.
• Cartilage injury and its surgical repair are covered in knee cartilage damage.

What does this page cover?

• What are knee injections for osteoarthritis?
• What do corticosteroid injections do?
• What do hyaluronic acid injections do?
• How do I decide about an injection?
• What if injections are not enough?
• When is urgent help needed?
• What should I do next?

What do corticosteroid injections do?

Corticosteroid injections give short-term relief, typically lasting weeks ^[1][2]. They ease symptoms. They do not repair the joint.

• The 2019 American College of Rheumatology and Arthritis Foundation (ACR/AF) guideline strongly recommends intra-articular glucocorticoid (corticosteroid) injections for knee and/or hip OA ^[1].
• Trials of intra-articular glucocorticoid injections have demonstrated short-term efficacy in knee OA ^[1].
• The 2019 OARSI guideline conditionally recommends intra-articular corticosteroids for knee OA, including for people with other health conditions ^[4].

More on how the guidelines weigh steroid injections

The ACR/AF guideline conditionally recommends intra-articular glucocorticoid injection over other forms of intra-articular injection, including hyaluronic acid preparations ^[1].

What do hyaluronic acid injections do?

Hyaluronic acid (HA) injections, also called viscosupplementation, place hyaluronic acid into the knee joint. The guidelines disagree. The decision is individual.

• The ACR/AF 2019 guideline conditionally recommends against hyaluronic acid injections for knee OA ^[1].
• The AAOS 2021 guideline, as quoted in a 2023 journal letter, says hyaluronic acid injections are not recommended for routine use in symptomatic knee OA, and that a specific subset of patients might benefit ^[3].
• The 2019 OARSI guideline conditionally recommends intra-articular hyaluronic acid for knee OA, including for people with other health conditions ^[4].
• The ACR/AF guideline notes that HA may be considered within shared decision-making after other options fail ^[1].

More on the ACR reasoning

When the ACR/AF guideline limited its analysis to trials with low risk of bias, the effect size of hyaluronic acid injections compared with saline injections approached zero ^[1].

How do I decide about an injection?

An injection decision is made at an assessment, with your own knee, history and goals in view. These questions can help.

• What symptom is the injection meant to ease, and for roughly how long?
• Have the core treatments been tried: education, exercise and, where it applies, weight management?
• What do the guidelines say about this injection, and where do they disagree?
• What are the risks and uncertainties for my knee?

What if injections are not enough?

Where symptoms are more advanced or do not improve with non-surgical care, additional procedures may be considered. Surgical options for the knee are described on the total knee replacement and partial knee replacement pages.

When is urgent help needed?

The list below applies to any knee problem. A knee that becomes suddenly very painful, hot, red and swollen, especially with a fever, is on it whether or not you have had an injection.

What should I do next?

For anyone weighing a knee injection, an assessment is a sensible next step. It brings together the patient’s story, an examination and any tests that help, so that the patient and clinician can decide what to do next. The assessment looks at the structure involved, the patient as a whole person and the goal they want to return to. An appointment supports an informed decision. It is not a commitment to an injection or to surgery.

• Read about the knee replacement consultation.
• Arrange a knee assessment when you are ready.
• Browse the Knee Hub for other knee problems, or more articles.
• Read more about Dr Sean Leo, who is named as the author of this page.

References

1. Kolasinski SL, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020;72(2):149-162. PMC11488261.
2. Gossec L, Dougados M. Do intra-articular therapies work and who will benefit most? Best Pract Res Clin Rheumatol. 2006;20(1):131-144. doi:10.1016/j.berh.2005.09.005. PMID 16483912.
3. Osteoarthritis and Cartilage. 2023;31(11):1526-1527 (letter quoting the American Academy of Orthopaedic Surgeons 2021 guideline). https://www.oarsijournal.com/article/S1063-4584(23)00860-9
4. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-1589. PMID 31278997.