Meta Analysis on Outcomes of Intra Articular Knee Injections: Hyaluronic Acid and Corticosteroid for Knee Osteoarthritis

Abstract

Background: Knee osteoarthritis is a prevalent degenerative joint disorder associated with chronic pain, functional limitation, and substantial socioeconomic burden. Intra-articular injections of hyaluronic acid and corticosteroids are widely used non-surgical interventions; however, their comparative efficacy, duration of benefit, and safety remain debated. Objective: To systematically evaluate and compare the effectiveness and safety of intra-articular hyaluronic acid and corticosteroid injections for pain reduction and functional improvement in patients with knee osteoarthritis. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA 2020 guidelines. Major electronic databases were searched from 2013 to 2025. Eligible studies reported validated pain and functional outcomes, including VAS and WOMAC scores. Random-effects meta-analyses were performed using standardized mean differences with 95% confidence intervals, and outcomes were analyzed across predefined short- and long-term follow-up intervals. Results: Eighteen randomized controlled trials were included in the quantitative synthesis. Corticosteroid injections demonstrated superior short-term pain relief, with significant reductions observed within the first 2–6 weeks. However, their effect diminished over time. In contrast, hyaluronic acid injections showed modest early effects but provided significantly greater pain reduction and functional improvement at 12 weeks and up to 6 months. Both interventions exhibited favorable safety profiles, with predominantly mild and transient adverse events. Conclusion: Intra-articular corticosteroids are effective for rapid, short-term symptom relief, whereas hyaluronic acid offers more durable improvements in pain and function. Treatment selection should be individualized based on patient characteristics, therapeutic goals, and desired duration of benefit.