What to Ask About Common Treatment Claims

What to ask before another steroid shot

A steroid shot may ease soreness most during the early weeks. Studies agree less about relief from shots repeated over a longer time.

One study tied repeat shots to loss of cartilage, the smooth cover over bone ends, without more relief than sterile salt water. That could mean added wear without added comfort.

Another study found no extra narrowing between the knee bones, which can happen as cartilage wears. People in that study also had less soreness and stiffness.

Ask why another shot makes sense now and how you will judge the result. If each round helps for less time, discuss a different choice.

What to ask about gel or PRP

Gel is a thick liquid placed inside the joint to act more like natural joint fluid. It hasn't been shown to rebuild worn parts of the joint.

Large reviews found that gel gave very little extra relief compared with salt-water treatment. On average, the difference may be too small for a person to feel.

PRP means platelet-rich plasma, made by spinning your blood until platelets collect in less plasma. Some studies found more relief later, while one large test found no clear gain over salt water.

Neither patients nor examiners knew who got PRP in that large test. Also, offices may spin the blood differently and produce different final mixtures.

What salt-water results mean

Saline is clean salt water used for comparison in many treatment studies. People given saline can still report real relief.

That doesn't mean the soreness was imagined or that every treatment works. Rest, time, and care from a medical team can each affect how someone feels.

A good study checks whether the treatment helped more than salt water did. Feeling better matters, but one person's account can't reveal which part helped.

What to weigh besides price

When I first read the studies, I was surprised that a higher price didn't mean firmer proof. Cost tells you what you'll pay, not how much relief you'll get.

Ask about likely relief, risks, repeat treatment, and the full cost. Keep home care, medicine, physical therapy, waiting, and surgery in the same talk.

If surgery may happen soon, tell the surgeon about any recent steroid shot. A shot given close to surgery has been linked with more infection risk.

Evidence sources

1. In a 2-year double-blind RCT of 140 patients with symptomatic knee OA and ultrasound synovitis, 40 mg intra-articular triamcinolone every 12 weeks produced significantly greater cartilage volume loss than saline (index compartment cartilage thickness change -0.21 mm vs -0.10 mm; between-group difference -0.11 mm, 95% CI -0.20 to -0.03) with no significant difference in knee pain.

   McAlindon TE, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.. JAMA, 2017.

2. A 2-year double-blind RCT of triamcinolone every 3 months versus saline found NO difference in joint space loss between groups and significantly improved pain and stiffness with repeated steroid injections, and the authors concluded that long-term intra-articular steroid injection is safe for the anatomical structure of the knee.

   Raynauld JP, et al. — Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial.. Arthritis Rheum, 2003.

3. A 2022 BMJ systematic review and meta-analysis of 169 trials (21,163 participants) found viscosupplementation produced only a small pain reduction versus placebo (SMD -0.08, 95% CI -0.15 to -0.02; about -2.0 mm on a 100 mm VAS), below the minimal clinically important difference, and trial sequential analysis indicated conclusive evidence of clinical equivalence with placebo since 2009.

   Pereira TV, et al. — Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis.. BMJ, 2022.

4. A 2025 network meta-analysis restricted to LARGE randomized trials (57 RCTs, 22,795 participants, 18 intra-articular interventions) found treatment effects were larger in the 35 high-risk-of-bias trials than in the 22 low/unclear-risk trials; excluding high-risk trials, triamcinolone had the highest probability of exceeding the minimal important difference at weeks 2 and 6, while hyaluronic acid had no effect on pain (SMD -0.04, 95% CrI -0.19 to 0.11) and higher odds of dropouts due to adverse events (OR 2.01) and serious adverse events (OR 1.86) than placebo.

   Pereira TV, et al. — Effectiveness and safety of intra-articular interventions for knee and hip osteoarthritis based on large randomized trials: A systematic review and network meta-analysis.. Osteoarthritis Cartilage, 2025.

5. The RESTORE randomized trial (288 participants, leukocyte-poor PRP, 3 weekly injections) found no significant difference from saline placebo at 12 months in knee pain (-2.1 vs -1.8 points; difference -0.4, 95% CI -0.9 to 0.2) or in medial tibial cartilage volume (-1.4% vs -1.2%), with 29 of 31 secondary outcomes also showing no between-group difference.

   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.

6. A systematic review of 105 clinical orthopaedic PRP studies found only 11 (10%) described the preparation protocol well enough to be repeated, and only 17 (16%) reported quantitative metrics on the composition of the final PRP product - so 'PRP' in one trial is frequently not the same product as 'PRP' in another.

   Chahla J, et al. — A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature.. J Bone Joint Surg Am, 2017.

7. A meta-analysis of 10 RCTs of RECURRENT intra-articular corticosteroid injections (2-8 injections per patient) found they often gave inferior or non-superior relief compared with hyaluronic acid, PRP, saline or orgotein at 3 months and beyond, and no benefit over placebo in pain or function at 12-24 months.

   Donovan RL, et al. — 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.

8. A meta-analysis of 14 placebo cohorts (1,076 patients) found intra-articular NORMAL SALINE alone produced statistically and clinically meaningful improvement in VAS pain and WOMAC scores lasting up to 6 months - meaning a large share of the improvement people attribute to an injection is not attributable to the drug in the syringe.

   Saltzman BM, et al. — The Therapeutic Effect of Intra-articular Normal Saline Injections for Knee Osteoarthritis: A Meta-analysis of Evidence Level 1 Studies.. Am J Sports Med, 2017.

9. Medicare Part B claims show hyaluronic acid injections rose from 1,090,503 services in 2012 to 1,209,489 in 2018 and total costs from $290.10 million to $325.02 million (2020 dollars) - utilisation and spending both increased despite the AAOS recommendation against routine use.

   Zhu KY, et al. — Hyaluronic Acid Injections for Knee Osteoarthritis: Has Utilization Among Medicare Beneficiaries Changed Between 2012 and 2018?. J Bone Joint Surg Am, 2022.