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Most people who come to see me about knee arthritis have already had an injection of some kind. Very few of them can tell me what was in it. That is not their fault. The injections get described in clinic as "a jab for the knee" and the differences between them rarely get explained, even though those differences change how long the relief lasts and whether the injection was ever likely to suit that particular knee in the first place.
There are three broad categories in common use in the UK. They work in genuinely different ways.
A corticosteroid injection is an anti inflammatory. It settles the inflamed lining of the joint, and when a knee is in an angry, swollen phase it can be very effective quite quickly. That is its strength. Its limitation is that it treats the flare rather than the joint, so the relief tends to be measured in weeks or a few months rather than years.
Steroid injections still have a clear place. If your knee has suddenly become hot and swollen, or you have an event coming up that you want to get through, or we are trying to work out whether the pain is coming from inside the joint at all, a steroid injection can be the right answer. What it is not is a long term plan. Repeated steroid injections into the same knee, year after year, are not something I encourage.
Hyaluronic acid is a substance your knee already makes. In an arthritic joint the fluid becomes thinner and less protective, and the idea behind these injections is to top that up. Durolane is one of the better known brands in the UK because it is given as a single injection rather than a course, which is why it comes up so often when people start searching.
Hyaluronic acid is gradually broken down and absorbed by the body. That is the important point. Whatever benefit you get from it fades as the material disappears, and most patients are looking at something in the order of six months before they are back where they started. Some people get very good relief in that window. Others notice very little, and it is difficult to predict in advance which group a given patient falls into.
Arthrosamid is a polyacrylamide hydrogel. It is not a lubricant and it is not a drug. Once injected it integrates into the lining of the joint and stays there, which is the whole reason its effect is measured in years rather than months. It is given as a single injection in clinic under sterile conditions and you walk out the same day.
The practical consequence is that Arthrosamid suits a different patient from the other two. If you have knee osteoarthritis, you have got as far as you can with weight management, exercise and painkillers, and you are not ready for a knee replacement or you are not yet a good candidate for one, this is the option that is likely to buy you meaningful time. That is the group I see the best results in.
It does not regrow cartilage. It does not reverse arthritis. The arthritis in your knee carries on doing what arthritis does, and the injection changes how much that hurts rather than what is happening to the joint surface.
It also does not work for everyone, and anyone who tells you otherwise is overselling it. In a knee that is severely worn, badly deformed or mechanically unstable, an injection is not going to hold the line for long and a replacement is usually the more honest conversation.
There is one further thing I mention to every patient. Arthrosamid is a relatively new treatment, and the evidence on what happens when someone who has had it goes on to need a knee replacement some years later is still building. I do not think that is a reason to avoid it. I do think it is a reason to have it explained to you properly rather than glossed over.
If the knee is inflamed and you need it settled now, a steroid injection is reasonable. If you want a single injection with a decent chance of getting you through the next few months, hyaluronic acid is reasonable. If you are trying to put off a knee replacement for as long as sensibly possible and you want one treatment rather than a repeating cycle, Arthrosamid is the one worth discussing.
The wrong question is which injection is best. The right question is which stage your knee is at, because that is what decides the answer.
Studies have followed patients for several years and the benefit appears to persist for that period in those who respond. Individual results vary, and a small number of patients notice little change at all.
Usually yes. Previous injections do not rule it out, although we would normally leave a gap after a recent steroid injection.
Not routinely at present. It is generally a self funded or insured treatment.
The injection itself takes a few minutes and is done with local anaesthetic. Some swelling and aching in the first few days is normal and settles.
I run knee clinics in Tunbridge Wells and Crowborough. Current fees are listed on the fees page.
It may delay one. It will not prevent one if the arthritis progresses to the point where the joint needs replacing.
If you are weighing up your options for an arthritic knee, you can read more about Arthrosamid injection and about knee arthritis on this site. Current fees are on the fees page, and you can book a consultation at one of my clinics in Kent and East Sussex.