Can Orthopedic Injections for Knee Pain Replace Surgery?
The knee is the joint most often affected by osteoarthritis, and knee replacement is one of the most common orthopedic surgeries in Canada. Wait times for this surgery can be long in several provinces, and many patients wonder whether injections could help them delay it, or even avoid it. The answer depends mainly on the stage of osteoarthritis and on the patient’s goals.
Understanding Orthopedic Injections for Knee Pain
Knee injections deliver a product directly into the joint. The main options are:
- Corticosteroids, to calm inflammation and swelling quickly.
- Hyaluronic acid viscosupplements, often called gel injections, to restore lubrication and cushioning.
- Combination products such as CINGAL®, which combine hyaluronic acid and a corticosteroid.
- Platelet-rich plasma (PRP), prepared from the patient’s own blood.
When Are Knee Injections Recommended?
Injections are generally considered for mild to moderate knee osteoarthritis when pain persists despite exercise, physiotherapy, weight management and oral or topical medication. They are also used to control flare-ups with swelling, or to relieve pain in patients who are waiting for surgery or who cannot undergo it because of their health.
How Do Knee Gel Injections Work?
In knee osteoarthritis, the hyaluronic acid in joint fluid becomes less concentrated and less viscous, so the joint loses part of its lubrication and shock absorption. Viscosupplementation restores these properties. In Canada, clinicians can choose between:
- Single-injection products such as MONOVISC®, DUROLANE® and SYNVISC-ONE®, which provide treatment in one visit.
- Multi-injection protocols such as ORTHOVISC® and SYNVISC®, given once a week over several weeks.
Relief appears gradually over a few weeks and can last up to six months or more in suitable patients.
Comparing Injections and Surgery for Knee Pain
| Criterion | Injections | Knee replacement |
| Invasiveness | Minimally invasive, a few minutes | Major surgery under anaesthesia |
| Recovery | 24 to 48 hours of relative rest | Several weeks to months of rehabilitation |
| Duration of effect | Weeks to months, repeatable | Long-lasting, often many years |
| Best suited for | Mild to moderate osteoarthritis | Advanced osteoarthritis with severe pain and disability |
Injections do not rebuild cartilage and cannot reverse advanced osteoarthritis. However, for many patients with mild to moderate disease, they can control symptoms well enough to postpone surgery and maintain an active life.
Effectiveness and Longevity of Knee Injections
- Corticosteroids: relief often within a few days, lasting a few weeks to a few months.
- Viscosupplements: gradual relief over a few weeks, which can last up to six months or more.
- Combination products: aim to provide both early and longer-lasting relief.
- PRP: gradual improvement, with results that vary between protocols.
Our article on which injection works fastest compares their speed of action.
Choosing the Right Knee Gel Injection
The choice between products depends on the clinician’s assessment, the number of visits the patient prefers, the product’s characteristics (molecular weight, cross-linking, volume) and coverage by private insurance. Some products contain hyaluronic acid of avian origin and are not suitable for people allergic to avian proteins. Clinics can compare all products in our orthopedic injections category.
How to Maximize Results After Injections
- Strengthen the quadriceps and hip muscles with a physiotherapy program.
- Choose low-impact activities such as walking, cycling, swimming or aquafitness.
- Maintain a healthy weight: every kilogram lost reduces the load on the knee.
- Wear supportive footwear and use ice grips on winter sidewalks.
- Follow the post-injection care instructions.
References
- Surakanti, A., et al. (2023). Surgical versus non-surgical treatments for the knee: A comparison of intra-articular injections and surgery outcomes in knee osteoarthritis. Journal of Orthopaedics and Sports Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC10010196/
- Top Doctors. (2020). Knee injections vs knee replacement surgery: Which is best? Top Doctors Medical Articles. https://www.topdoctors.co.uk/medical-articles/knee-injections-vs-knee-replacement-surgery-which-is-best/
- Medical News Today. (2022). Knee injection therapy: Understanding knee injections and surgery options for osteoarthritis. Medical News Today. https://www.medicalnewstoday.com/articles/310606
- Scripps Health. (2024). Knee injection vs. knee replacement surgery: Which is right for you? Scripps.org. https://www.scripps.org/news_items/7184-knee-injection-vs-knee-replacement-surgery-which-is-right-for-you
- Florida OrthoCare. (2024). Cortisone shots vs. knee surgery: Benefits and considerations. Florida OrthoCare. https://florthocare.com/knee-pain/
