Knee osteoarthritis is a common cause of pain for people in their 60s. When symptoms start to interfere with daily activities, many patients begin asking an important question: what injection should be considered first?
Before considering injections, it’s important to start with conservative lifestyle strategies. These steps can sometimes reduce symptoms enough that more advanced treatments are unnecessary.
Start With Conservative Treatment First
If you have knee osteoarthritis, the first step should always be optimizing what you can control.
Focus on strengthening exercises, particularly for the legs and core. This can be done through physical therapy or through a consistent home exercise program. Stronger muscles can help support the knee joint and improve stability.
Certain over-the-counter supplements may also help support joint health and reduce inflammation. Options such as glucosamine, omega-3 fatty acids, and curcumin are considered low-risk and may be preferable to long-term use of pain medications or anti-inflammatory drugs.
Another key factor is weight management. Every pound of excess body weight can place roughly four additional pounds of pressure on the knees. Losing even 15–20 pounds can significantly reduce stress on the joint.
Metabolic health also matters. If blood sugar levels are not well controlled or if someone is metabolically unhealthy, it may increase inflammation throughout the body, including in the joints.
Finally, consider activity modification. If you regularly perform very heavy weightlifting or high-impact activity, your knees may need time to build strength and stability before returning to those levels.
If these conservative steps are not enough to control pain, then injection treatments may be considered.
Steroid Injections
In many cases, the first injection patients are offered is a corticosteroid injection. These are widely available and relatively inexpensive.
Steroids work by reducing inflammation in the joint, which can provide pain relief. However, the benefit is typically short-term, lasting from several days to a few months.
There are also potential downsides if used too frequently. Steroid injections may contribute to tissue or cartilage degradation over time. They can also affect metabolic health, potentially influencing blood sugar, blood pressure, and weight. Repeated exposure may even suppress adrenal gland function.
Because of these risks and their temporary benefit, steroid injections are not always the best first-line solution.
Hyaluronic Acid (Gel) Injections
Another commonly recommended option is hyaluronic acid injections, sometimes referred to as gel injections.
These treatments are considered low risk and may provide longer relief than steroids, sometimes lasting up to six months. They work by helping reduce inflammation within the joint.
However, while they can improve symptoms, they do not address the underlying problem of joint instability.
Orthobiologic Injections
A different approach is to focus on treating the underlying cause of pain. In many cases of knee osteoarthritis, pain is related to joint instability and weakened soft tissue structures, such as ligaments or the meniscus.
Orthobiologic treatments aim to address these issues.
Three options are commonly used:
Prolotherapy:
For mild arthritis or mild instability, prolotherapy uses dextrose injections to strengthen ligaments and help reduce joint inflammation. Multiple treatments over several months may be needed.
Platelet-Rich Plasma (PRP):
For moderate arthritis or instability, PRP uses platelets from the patient’s own blood. The growth factors in platelets may support tissue healing and improve joint stability.
Bone Marrow Cell Therapy:
For more advanced arthritis or greater instability, bone marrow–derived stem cell treatments may be considered.
Choosing the Right Option
The best injection option depends on several factors, including the severity of arthritis, overall health, and which treatments have already been tried.
For many patients who have already optimized lifestyle factors but still experience knee pain, orthobiologic treatments such as prolotherapy, PRP, or bone marrow cell therapy may be appropriate next steps.
These approaches focus on improving joint stability, reducing inflammation, and helping patients return to better function and quality of life.
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