Should I ask about a steroid shot or blood-based care?

Which shot may start helping sooner?

A steroid shot may ease soreness sooner. Relief can fade, so repeat use needs a doctor talk. Ask what a short spell of relief would help you do. That answer matters before a long drive.

PRP may take longer before soreness changes. Some knee research found it helped longer than steroid. Other knee research found no clear gain over salt water. Those findings don't predict one person's result.

Clinics may start with different amounts of blood. Their preparation steps can differ too. Those choices affect the platelets in the finished shot. Concentrated PRP means more platelets than the starting blood.

The term biologic therapies includes care prepared from blood. PRP is one such choice. Ask exactly what the clinic would prepare. Then ask why that choice fits the joint.

What should I know before paying?

Ask how many visits you'll need. Get the full price before agreeing. Find out whether return checks cost more. Insurance may cover one choice but not another.

Blood thinners and other medicines can matter. Don't stop any medicine on your own. Give the doctor a full medicine list. Ask what to take before the visit.

Ask when to judge relief at home. Also ask when a return exam is due. Learn which soreness after the shot is expected. Fast swelling may need a same-day call.

Choose one task to measure each week. Use walking distance, sleep, or getting from a chair. Write down the same task each time. Those notes can guide the return visit.

Evidence sources

1. The 2015 Cochrane review of 27 trials (1,767 participants) found intra-articular corticosteroid better than sham for knee OA pain (SMD -0.40, 95% CI -0.58 to -0.22; NNTB 8), but the benefit decayed with time: moderate at 1-2 weeks, small at 13 weeks, and no evidence of any effect at 26 weeks. All outcomes were graded LOW quality.

   Jüni P, et al. — Intra-articular corticosteroid for knee osteoarthritis.. Cochrane Database Syst Rev, 2015.

2. 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.

3. 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.

4. A 2024 network meta-analysis of 48 studies (9,338 knees) at minimum 6-month follow-up ranked PRP first for pain and function (SUCRA 91.5), then BMAC (76.5) and hyaluronic acid (53.1), with corticosteroid (15.2) barely above placebo (13.7) at that time point.

   Jawanda H, et al. — Platelet-Rich Plasma, Bone Marrow Aspirate Concentrate, and Hyaluronic Acid Injections Outperform Corticosteroids in Pain and Function Scores at a Minimum of 6 Months as Intra-Articular Injections for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis.. Arthroscopy, 2024.

5. A meta-analysis of eight low-risk-of-bias studies (648 patients) found PRP significantly better than corticosteroid for pain, stiffness and function at 3, 6 and 9 months, with the largest effects at 6 months (SMD -0.78) and 9 months (SMD -1.63), and found triple PRP injections superior to single injections over 12 months.

   McLarnon M, et al. — Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis.. BMC Musculoskelet Disord, 2021.

6. 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.

7. A 2024 systematic review of eight randomized trials (937 patients) found BMAC improved pain and function from baseline and beat hyaluronic acid on pain at 6 and 12 months, but the differences did NOT exceed the minimal clinically important difference, and no significant differences emerged against other injectables.

   Han JH, et al. — Bone Marrow Aspirate Concentrate Injections for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials.. Orthop J Sports Med, 2024.

8. A systematic review of eight studies (299 knees, mean follow-up 12.9 months) found BMAC improved 34 of 36 patient-reported outcomes from baseline, but all three comparative studies failed to show BMAC superior to other biologic injections or to placebo - a finding the authors weigh against its high cost.

   Keeling LE, et al. — Bone Marrow Aspirate Concentrate for the Treatment of Knee Osteoarthritis: A Systematic Review.. Am J Sports Med, 2022.