Joint pain from osteoarthritis and other degenerative conditions can significantly affect daily life. While joint replacement surgery is sometimes the definitive treatment, many people wonder whether non-surgical options—such as injections into the joint—can delay or even avoid surgery.
Let’s take a closer look at the three main types of injections—corticosteroid (steroid), hyaluronic acid (HA), and platelet-rich plasma (PRP)—and what the latest research says about their role in delaying surgery.
Corticosteroid (Steroid) Injections
What they do:
Steroid injections reduce inflammation inside the joint. They often provide rapid relief of pain and stiffness, usually within days.
Evidence:
- Relief is short-term, often lasting weeks to a few months.
- A large study of patients with hip osteoarthritis found that those who received steroid injections delayed hip replacement by around two years, though this was only a subset of patients.
- For the knee, results are mixed. Steroids reliably reduce symptoms, but whether they delay knee replacement long-term is less clear.
- Concerns that repeated steroid injections accelerate cartilage loss have been largely tempered by newer studies, which suggest they are generally safe when used judiciously.
Limitations:
- Relief fades, often requiring repeat injections.
- Timing is important—having a steroid injection too soon before surgery may increase the risk of complications such as infection.
Hyaluronic Acid (HA) Injections
What they do:
HA is a natural substance in joint fluid. In osteoarthritis, its quality and amount decline. HA injections aim to restore lubrication, cushioning, and reduce inflammation.
Evidence:
- Several studies show that HA injections may postpone knee replacement surgery by 1–3 years, particularly when given in repeated courses.
- HA is often more effective in earlier stages of osteoarthritis and less so in advanced cases.
- Some clinical guidelines remain cautious, as results can vary between products and patients.
Limitations:
- Relief may take several weeks to appear.
- The benefit is modest in severe arthritis with major structural changes.
Platelet-Rich Plasma (PRP) Injections
What they do:
PRP is prepared from a patient’s own blood. It contains concentrated platelets that release growth factors and anti-inflammatory proteins, which may promote tissue healing.
Evidence:
- Clinical trials suggest PRP can provide longer pain relief than both steroids and HA in mild to moderate knee arthritis.
- In some long-term studies, the majority of patients who had PRP injections were able to avoid or delay knee replacement for several years.
- The best results are seen in people with less advanced arthritis.
Limitations:
- PRP methods vary (different concentrations and preparation techniques), which can affect outcomes.
- It is not yet universally covered by insurance or standardised in all health systems.
Comparing the Options
- Steroids: Best for short-term relief; helpful for symptom control but unlikely to delay surgery for many years.
- HA: Can delay surgery, particularly with repeated courses; most effective in early disease.
- PRP: Promising for longer-lasting relief, especially in mild-to-moderate cases; evidence is growing but not yet standardised.
Factors That Influence Success
- Stage of arthritis: Earlier disease responds better.
- Patient goals: Some want a short reprieve; others seek to delay surgery for years.
- Injection protocol: Type, frequency, and technique matter.
- Other treatments: Exercise, weight management, and bracing can enhance the effect.
- Timing before surgery: Injections too close to surgery may increase risk.
Key Questions Patients Often Ask
Will one steroid injection delay knee replacement for years?
Likely not—relief usually lasts only weeks to months.
Is hyaluronic acid better than steroids for delaying surgery?
Yes, evidence suggests HA is more effective for longer-term delay, particularly in knee arthritis.
Can PRP replace surgery altogether?
No. PRP may help delay surgery, especially in earlier stages, but severe arthritis often still requires replacement.
Are there risks if I have surgery after injections?
Yes—especially with steroid injections, which should not be given too close to surgery due to infection risk.
Conclusion
Joint injections can delay the need for surgery—but how much depends on the injection type, the stage of arthritis, and the patient’s circumstances.
- Steroids: good for fast, short-term relief.
- HA: more promising for longer delays (1–3 years).
- PRP: the most encouraging for durable benefit in early disease.
They are not permanent solutions but can provide valuable time, improved mobility, and better quality of life while patients prepare for or postpone surgery.
