Evidence-Based Knee Pain Treatment in Sydney

Intra-Articular Injections for Knee Osteoarthritis

Intra-articular knee injections aim to reduce pain and inflammation directly within the joint. However, not all injections work the same way, and results vary between individuals.

Corticosteroid Injections

Short-term pain relief, particularly during inflammatory flares

Corticosteroid injections reduce joint inflammation and have been widely used in knee osteoarthritis.

Evidence summary:

• Rapid pain relief, often within days
• Benefit typically lasts 2–6 weeks
• Most effective when there is joint effusion or synovitis
• Repeated injections may be associated with cartilage volume loss

Role in treatment:

Best used for acute flare-ups or short-term symptom control, rather than ongoing management.

Hyaluronic Acid Injections (Viscosupplementation)

Variable benefit — some patients improve

Hyaluronic acid injections aim to improve joint lubrication and shock absorption.

Evidence summary:

• Mixed results in clinical trials
• Some patients experience modest symptom relief lasting several months
• More effective in mild to moderate knee osteoarthritis
• Limited benefit in advanced “bone-on-bone” arthritis

Role in treatment:

May be considered for selected patients who cannot tolerate NSAIDs or prefer a non-steroidal option.

Platelet-Rich Plasma (PRP) Injections

Growing evidence for symptom improvement in selected patients

PRP uses the patient’s own blood to deliver concentrated platelets and growth factors into the knee joint.

Evidence summary:

• Increasing number of randomised trials show better pain and function outcomes compared with placebo or hyaluronic acid
• Benefits may last 6–12 months
• Most effective in early to moderate osteoarthritis
• Results depend on PRP preparation methods, which are not yet standardised

Role in treatment:

Often considered in younger or more active patients seeking longer-lasting symptom relief without corticosteroids.

Stem Cell Injections

Experimental — not standard of care

Stem cell injections are sometimes marketed as regenerative treatments for knee arthritis.

Evidence summary:

• Insufficient high-quality evidence to support routine use
• No convincing proof of cartilage regeneration in knee OA
• Considered experimental by major international guidelines

Current recommendation:

Not offered as routine treatment at SIR as it is outside of research settings.

When Knee Injections Are No Longer Enough

For many patients, intra-articular injections provide temporary relief only. When pain persists despite appropriate injections, image-guided minimally invasive treatments such as Genicular Nerve Ablation or Genicular Artery Embolisation may be the next steps — especially for patients wishing to delay or avoid knee replacement surgery.

Next-Step Treatments Available at Sydney Interventional Radiology

Genicular Nerve Radiofrequency Ablation (RFA)

Targeted pain control without surgery

Genicular nerve ablation uses image guidance to selectively treat the small sensory nerves around the knee that transmit pain signals.

Evidence highlights:

• Effective for moderate to severe knee osteoarthritis pain
• Can provide pain relief for 6–12 months or longer
• Does not damage the knee joint
• Suitable for patients not ready for knee replacement

Genicular Artery Embolisation (GAE)

Treating knee pain by reducing inflammation

GAE is an advanced minimally invasive procedure performed by interventional radiologists. It targets abnormal inflamed blood vessels around the knee that contribute to chronic pain.

Evidence highlights:

• Growing international evidence showing significant pain and function improvement
• Minimally invasive, performed through a tiny puncture
• Preserves future surgical options, including knee replacement
• Particularly suitable for patients with persistent pain despite injections

At Sydney Interventional Radiology, GAE is performed using advanced imaging and carefully selected criteria to maximise safety and outcomes.

A Personalised, Evidence-Based Approach at SIR

There is no single “best” treatment for knee osteoarthritis. At SIR, we tailor treatment based on:

• Severity of arthritis
• Inflammatory features
• Functional limitation
• Patient goals and preferences

Our focus is on minimally invasive alternatives to surgery, helping patients to stay active and to delay knee replacement where possible.

Key Takeaway

Intra-articular injections play an important role in knee osteoarthritis management, but their effects are often temporary. When injections are no longer effective, genicular nerve ablation and genicular artery embolisation offer evidence-based, minimally invasive options available at Sydney Interventional Radiology.

References

1. McAlindon TE et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014.
2. Kolasinski SL et al. 2020 ACR guideline for the management of osteoarthritis. Arthritis Care Res. 2020.
3. McAlindon TE et al. Intra-articular triamcinolone and cartilage loss. JAMA. 2017.
4. Bannuru RR et al. Comparative effectiveness of knee OA treatments. Ann Intern Med. 2015.
5. Dai WL et al. PRP for knee osteoarthritis: meta-analysis. Arthroscopy. 2017.
6. Filardo G et al. PRP injections for knee OA. Am J Sports Med. 2015.
7. NICE. Osteoarthritis in over 16s: diagnosis and management. 2022.
8. Okuno Y et al. Clinical outcomes of genicular artery embolization for knee osteoarthritis. Radiology. 2017.

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