by Dr Ameer Ibrahim
Sport & Exercise Medicine Physician

Intra-articular injections commonly include corticosteroids, hyaluronic acid (viscosupplementation), or newer biologics including PRP. Understanding relative efficacy, durability, and safety is key to choosing among them.

Efficacy Comparisons

• PRP vs HA
  • Meta-analyses and systematic reviews (2024--2025) consistently show PRP has superior outcomes in pain and function compared to HA, particularly in moderate-term (3--12 months) follow-up. SAGE Journals
  • The "critical overview" reported many reviews find PRP outperforms HA, but cautioned the low methodological quality of many studies. SpringerLink
  • A 2024 meta-analysis found combination PRP + HA may further enhance effect versus PRP or HA alone. BioMed Central
• PRP vs Corticosteroids (CS)
  • Corticosteroids provide rapid short-term pain relief, often peaking within weeks, but effects wane by ~6--8 weeks. PRP tends to have slower onset but more durable effect over 6--12 months. Frontiers
  • Trials show that while CS may outperform PRP in the first month, PRP overtakes CS at 3--6 months.o A systematic review with fragility index analysis of RCTs (Oeding et al., 2024) suggests many PRP vs alternative injection studies are statistically fragile, underscoring caution about overinterpretation. Orthobullets.com

Safety & Side Effect Profiles

• PRP and HA show similar safety profiles; both have mostly mild, local adverse effects (pain, swelling). No serious complications reported in trials. MDPI
• Corticosteroids carry potential risks: cartilage damage with repeated use, systemic steroid effects (glycemic impact), joint infection risk (though rare).
• Long-term repeated CS injections are not advisable; PRP may offer safer long-range biologic support.

Durability & Repeatability

• HA may need repeated courses every 6--12 months; its efficacy often plateaus.
• PRP, when optimized, may reduce the need for frequent repeats, though "booster" injections are being studied.
• CS is not typically repeated on short cycle due to deleterious effects with repetition.

Practical Guidance Based on Evidence

• For rapid analgesia, short-term relief, a corticosteroid may be chosen initially; but for longer-term structural & symptomatic benefit, PRP seems superior beyond ~3 months.

• Use HA in patients who cannot undergo biologics; PRP is more appealing for longer-lasting effect.

• Combination strategies (PRP + HA) show early promise from meta-analysis (Zhang et al., 2024). BioMed Central

• Always counsel patients that PRP has slower onset but potentially more durable benefit; some may need sequential or booster injections.

Conclusion

PRP tends to outperform HA and corticosteroids in medium-term outcomes, with better safety for longer use. The choice between them should consider onset vs durability, patient comorbidities, cost, and joint status.