What Happens After a Knee Injection? – New Research Sheds Light on Negative Effects of Repeated Cortisone vs. Hyaluronic Acid

At the Orthohealing Center, we believe that healing should not only ease pain — it should protect and preserve the joint for the long-term. A recent study published in Radiology (Bharadwaj et al., 2025) adds powerful new evidence to what we’ve long observed in our clinical practice: not all knee injections are created equal.

The study, drawn from the extensive Osteoarthritis Initiative, followed 210 individuals with knee osteoarthritis (OA) who had received either corticosteroid or hyaluronic acid (HA) injections. MRI scans were reviewed using the Whole-Organ MRI Score (WORMS) to evaluate cartilage, bone marrow lesions, and meniscal integrity over a two-year period.

The findings were striking.

Corticosteroid Injections: Short-Term Relief, Long-Term Risk
While cortisone (a type of corticosteroid) has been widely used to reduce inflammation and offer temporary relief, the study found that these injections were associated with greater progression of joint damage on MRI over time. Specifically, those receiving corticosteroid injections experienced significantly more cartilage breakdown and worsening joint structure compared to both HA-treated patients and matched controls who received no injection.

This confirms growing concerns in the orthopedic community: repeated cortisone use may accelerate the very disease it’s meant to manage. The Orthohealing Center’s approach to inflammation prioritizes homeopathic injectables, PRP, and other natural anti-inflammatory treatments. (As an alternative for time-sensitive cases — such as before travel or with severe swelling —our physicians may administer a combination of low-dose cortisone injections, hyaluronic acid, and / or Toradol.)

Hyaluronic Acid Injections: A Protective Option for Our Patients
In contrast, HA injections — designed to mimic the natural lubricating fluid in the knee — were associated with less joint degeneration and even a decrease in MRI-visible damage two years post-injection. Patients also experienced meaningful pain reduction, though slightly less than the cortisone group. Importantly, HA seems to offer both symptom relief and joint preservation — a rare combination.

Unlike corticosteroids, these treatments do not harm cartilage, and in many cases, they may support its health. They’re particularly suited for patients with early to moderate OA who want to stay active, delay surgery, and heal smarter.

The Bottom Line for Patients?
While cortisone may offer quick relief, it may come at a long-term cost to your joint health. Hyaluronic acid is a gentler option with protective benefits.

And at Orthohealing Center, we believe the future of joint care lies in harnessing the body’s own healing power with a broad spectrum of biologic therapies aimed at reducing pain and helping preserve joint health.

For more information on hyaluronic acid injections and additional Orthohealing Center offerings, schedule a consultation today: (310) 453-5404.

Let’s work together to protect your knees — for a vital, active life.

Source
Bharadwaj UU, Lynch JA, Joseph GB, et al. Intra-articular Knee Injections and Progression of Knee Osteoarthritis: Data from the Osteoarthritis Initiative. Radiology. Published online 2025. doi:10.1148/radiol.233081. PMCID: PMC12127947.