Which Knee Injection Is Right for Arthritis. PRP,Hyaluronic Acid, Arthrosamid or Steroid
Four injections are commonly offered for knee osteoarthritis in London. NICE advises against hyaluronic acidand limits steroid to 2 to 10 weeks of relief. PRP beat hyaluronic acid across 26 randomised trials but failedagainst placebo in a 288-patient JAMA trial. Arthrosamid has 1 randomised trial. Which suits you depends onyour stage of disease and what you need.
Key points
The NICE osteoarthritis guideline NG226 says do not offer intra-articular hyaluronan injections, and thatcorticosteroid injections should be considered only when other treatments have failed, with relief lasting 2to 10 weeks and no evidence of benefit beyond 3 months.
A 2025 meta-analysis in the Journal of Experimental Orthopaedics of 26 randomised trials and 1,650knees found PRP gave superior WOMAC and pain scores to hyaluronic acid at 6 and 12 months, withhigher platelet concentrations linked to greater improvement.
A 2021 randomised trial of 288 patients in JAMA found PRP no better than saline placebo for mild tomoderate knee osteoarthritis at 12 months, and NICE describes the PRP evidence as limited in quality.
Arthrosamid, a permanent polyacrylamide hydrogel, has been tested in 1 randomised trial of 239 adultsagainst hyaluronic acid and an open-label study of 49 patients showing a 17.7 point fall in WOMAC pain at52 weeks. It is listed in London from £3,000 for a single injection.
If you are weighing these options for your own knee, message us on WhatsApp or email team@thewellnesslondon.com and a doctor will look at your imaging before recommending any of them.
What the four injections actually are
A corticosteroid injection places an anti-inflammatory drug in the joint. It works within days and wears offwithin weeks. It is the cheapest option, widely available on the NHS, and the one NICE still endorses for short-term relief.
Hyaluronic acid, often called gel or viscosupplementation, is a synthetic version of the lubricating fluid in ahealthy joint. It was popular for 2 decades. NICE reviewed the evidence in 2022 and concluded it showed noimprovement in quality of life, function or pain in knee or hip osteoarthritis, with potential harm in the hip, andadvised that it should not be offered.
Platelet rich plasma is made from your own blood, spun to concentrate the platelets and their growth factors,then injected into the joint. It aims to change the biological environment rather than lubricate or numb it. It isusually given as 1 to 3 injections and repeated after 6 to 12 months if it helps.
Arthrosamid is different in kind. It is a non-absorbable hydrogel of 97.5 percent water and 2.5 percent cross-linked polyacrylamide, given as a single 6 ml injection, and it stays in the joint permanently. It is the only suchhydrogel licensed for intra-articular use in knee osteoarthritis.
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What NICE says about each of them
NICE guideline NG226 on osteoarthritis, published in October 2022, is the reference point for any injectiondecision in the UK, and it is worth knowing what it actually says because most clinic websites do not quote it.
On hyaluronic acid the wording is unambiguous. Do not offer intra-articular hyaluronan injections to manageosteoarthritis. The committee found inconsistent benefit across joints and some potential harms, particularlyin the hip, and judged the results generalisable to every form of osteoarthritis.
On corticosteroid the guideline says injections can be considered when other pharmacological treatments areineffective or unsuitable, or to support therapeutic exercise, and that patients must be told relief lasts only 2 to10 weeks. The committee found no evidence of benefit beyond 3 months.
On PRP the relevant document is interventional procedures guidance IPG637, which permits PRP for kneeosteoarthritis under special arrangements and describes the evidence as limited in quality and quantity. OnArthrosamid there is no NICE guidance yet. That absence does not mean it does not work. It means theevidence base is young, and a patient paying £3,000 should know that before rather than after.
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PRP against hyaluronic acid
This is the most tested head to head comparison of any two knee injections, and it consistently favours PRP.The 2025 meta-analysis in the Journal of Experimental Orthopaedics pooled 26 randomised trials and 1,650knees and found PRP produced superior improvements in both WOMAC total score and pain at 6 and 12months. A subgroup analysis found PRP preparations with higher platelet concentrations gave greaterimprovements, which is a point in favour of asking any clinic how its PRP is prepared. A 2023 meta-analysis of30 studies and 2,733 patients reached the same conclusion on WOMAC and IKDC scores.
The limitation of this comparison is that hyaluronic acid is a low bar. If NICE is right that it does little, beating itproves less than it sounds. What the placebo-controlled evidence adds is caution. The 2021 JAMA trialrandomised 288 adults with mild to moderate knee osteoarthritis to 3 weekly injections of leukocyte-poor PRPor saline and found no meaningful difference in pain or cartilage volume at 12 months. A 2026 randomised trialin the Journal of Orthopaedic Surgery and Research pointed the other way, with 90 late stage patients onreplacement waiting lists doing better on PRP than on steroid or oral anti-inflammatories at 6 months. Bothfindings are real, and both should be on the table when you decide.
Send your knee imaging on WhatsApp and a doctor will tell you whether your stage of disease is one the PRPevidence supports treating.
Arthrosamid. What the evidence shows and what it does well
Arthrosamid deserves a fair hearing, because for some patients it is the right choice. Its appeal is simplicity.One ultrasound-guided injection, no course, no repeat visits, and published follow up that runs longer thanmost PRP trials. In the open-label study of 49 participants with a mean age of 70, WOMAC pain fell by 17.7points on a 100 point scale at 52 weeks, with 46 completing the extension. Four case series reportimprovements in pain, stiffness and function maintained from 6 months to 3 years. A 2026 review described itas a therapeutic option in its own right, particularly where steroid has stopped working.
The honest limit is the depth of the evidence. Only one randomised controlled trial has been conducted. Itrandomised 239 adults to a single injection of Arthrosamid or hyaluronic acid and found numerically superiorresults for the hydrogel, but that is a comparison against a treatment NICE says not to use, not against placeboor PRP. There is no head to head trial against PRP. And because the gel is permanent, there is no undoing apoor response, which is why the assessment beforehand matters more than for any other injection on this list.
Arthrosamid is generally the right destination for a patient with established, symptomatic osteoarthritis whohas exhausted steroid, wants a single long-acting injection, is not yet a surgical candidate, and can accept a£3,000 fee for a treatment with 1 randomised trial behind it.
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Three questions that decide it
Rather than ranking the four injections, work through these questions with any clinician you see. The answersnarrow the field quickly.
What stage is the knee. Mild to moderate disease, Kellgren Lawrence grade 1 to 3, is where PRP andArthrosamid have their evidence. Grade 4 bone on bone disease responds less predictably to all four, and thehonest conversation there is usually about surgery, with an injection as a bridge rather than a plan.
What do you need the injection to do. Get through the next 6 weeks, and steroid is the rational choice and thecheapest. Hold for a year with a chance of longer, and the choice is between PRP and Arthrosamid. Lubricatethe joint, and NICE says that mechanism does not deliver.
What has already been tried. A first injection is different from a fourth. Repeated steroid into an arthritic kneeis now approached with caution, since a 2017 trial of 140 patients in JAMA found triamcinolone every 12 weeksfor 2 years caused greater cartilage volume loss than saline with no pain advantage. If steroid has faded 2 or 3times, that history argues for a different mechanism, not another dose.
Whichever injection you choose, a 2026 meta-analysis in Disability and Rehabilitation of 6 randomised trialsand 314 patients found structured exercise after PRP reduced pain more than PRP alone, and no injection onthis list replaces that.
Our doctors put it this way. The most expensive injection is the wrong one. Every option here helpssomebody, and the only way to know which is yours is to diagnose the knee first and choose themechanism second.
Message us on WhatsApp with your stage of arthritis if known, what injections you have already had, and anyimaging, and a doctor will give you a straight answer.
What none of these injections does
None of them regrows cartilage in any way that is currently proven, and none is a substitute for kneereplacement where a surgeon says replacement is appropriate. PRP and Arthrosamid are not routinelycommissioned by the NHS and private medical insurance rarely covers either. PRP will not help everyone evenin mild to moderate disease, and a proportion of patients report no improvement. Arthrosamid cannot beremoved if it does not help. Hyaluronic acid is still widely sold in London despite the NICE position, and a clinicoffering it should be able to explain why it disagrees with the guideline.
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What each knee injection costs in London
Arthrosamid sits at the top of the market. It is listed in London from £3,000 for a single injection includingconsultation and ultrasound, £5,500 for 2 and £8,000 for 3, with the same price across joints. Specialistcentral London clinics commonly charge from around £780 to £900 or more per image guided PRP injectionincluding assessment, with a course of 2 to 3 taking a plan past £2,000. Image guided steroid injections incentral London are commonly quoted between £250 and £475. Hyaluronic acid packages start from around£250 plus consultation.
The cheapest injection on that list is the one NICE advises against, and the second cheapest lasts 2 to 10weeks. The price that matters is the cost per month of relief, plus the cost of the wrong choice. A £3,000injection that holds for 2 years and a £900 injection repeated yearly land in the same place. A £250 injectionthat does nothing is the most expensive of all.
Care at The London PRP Clinic by The Wellness is doctor-led and priced below flagship central London rates,with your exact figure confirmed at the free suitability review once a doctor knows which injection, if any, yourknee needs.
Ask about the cost for your knee on WhatsApp and we will explain what the review covers.
The free suitability review
Every enquiry here starts with a free, doctor-led suitability review rather than a booking. A GMC-registereddoctor assesses you and gives one of two answers. Either you are approved for treatment, with a clear planand realistic expectations for your knee and your stage of disease, or you are not approved, with an honestexplanation of what would serve you better, whether that is a steroid injection, Arthrosamid elsewhere,physiotherapy, or a surgical opinion.
We decline a meaningful share of the people who enquire. That is deliberate. A clinic that approves everyone isoptimising for bookings, not outcomes.
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Why people choose The London PRP Clinic by The Wellness
An 87 percent patient success rate across treatments.
More than 187 five star reviews.
Every treatment performed by a GMC-registered doctor.
100 supervised treatments completed by every clinician before they treat a patient here unsupervised.
A 32 percent average density increase reported in our hair restoration programme.
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Frequently asked questions
What is the best injection for knee arthritis
There is no single best injection. NICE advises against hyaluronic acid and limits steroid to short-term relief.PRP beat hyaluronic acid across 26 randomised trials but not placebo in a 288-patient JAMA trial. Arthrosamidhas 1 randomised trial. The right choice depends on your stage of disease, what you need it to do, and whatyou have already tried.
Is PRP better than hyaluronic acid for knees
Across 26 randomised trials and 1,650 knees, PRP gave better WOMAC and pain scores than hyaluronic acidat 6 and 12 months. NICE advises against hyaluronic acid altogether, so PRP beating it says less than itsounds, and PRP still failed against placebo in one large trial.
Is Arthrosamid better than PRP
Nobody knows. There is no head to head trial. Arthrosamid has 1 randomised trial against hyaluronic acid andopen-label data to 52 weeks. PRP has dozens of trials with mixed results. Arthrosamid is permanent and singledose. PRP is repeatable and biological.
Why does NICE not recommend hyaluronic acid injections
The 2022 NICE guideline NG226 found hyaluronan injections showed no improvement in quality of life,function or pain in knee or hip osteoarthritis, with potential harm in the hip, and concluded they should not beoffered for any form of osteoarthritis.
How long does each knee injection last
NICE puts steroid relief at 2 to 10 weeks. PRP trials show benefit at 6 to 12 months with repeat coursescommon. Arthrosamid case series report improvement maintained from 6 months to 3 years from a singleinjection. Duration varies by patient and disease stage.
Can I have PRP if I have already had Arthrosamid
The gel is permanent, so PRP would be given into a joint that still contains it. There are no trials of thatcombination. A doctor would want to see the knee on ultrasound and understand why the first injection did nothelp before recommending anything further.
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References
NICE, 2022. Osteoarthritis in over 16s, diagnosis and management, guideline NG226.https://www.nice.org.uk/guidance/ng226/chapter/Recommendations
NICE, 2019. Platelet-rich plasma injections for knee osteoarthritis, interventional procedures guidanceIPG637. https://www.nice.org.uk/guidance/ipg637/chapter/1-Recommendations
Journal of Experimental Orthopaedics, 2025. Platelet-rich plasma compared to viscosupplementation inthe treatment of knee osteoarthritis, a meta-analysis of 26 randomised trials. Summary athttps://myorthoevidence.com/AceReport/Show/platelet-rich-plasma-compared-to-viscosupplementation-in-the-treatment-of-knee-osteoarthritis
2023 meta-analysis of 30 studies and 2,733 patients, PRP versus hyaluronic acid for knee osteoarthritis.Evidence library entry, URL to be added before publication.
JAMA, 2021. Bennell et al. Effect of intra-articular platelet-rich plasma vs placebo injection on pain andmedial tibial cartilage volume in patients with knee osteoarthritis, the RESTORE randomised clinical trial.https://pubmed.ncbi.nlm.nih.gov/34812863/
Journal of Orthopaedic Surgery and Research, 2026. Intra-articular platelet-rich plasma demonstratessuperior clinical and serum biomarker outcomes compared with corticosteroids and NSAIDs in late-stageknee osteoarthritis, a randomised controlled trial. https://link.springer.com/article/10.1186/s13018-026-07013-w
Efficacy of novel polyacrylamide hydrogel injection for osteoarthritis, a review.https://pubmed.ncbi.nlm.nih.gov/42150308/
Journal of Orthopaedic Surgery and Research, 2024. Bliddal et al. Effectiveness and safety ofpolyacrylamide hydrogel injection for knee osteoarthritis, results from a 12-month follow up of an open-label study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11064315/
JAMA, 2017. McAlindon et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume andpain in patients with knee osteoarthritis, a randomised clinical trial.https://pmc.ncbi.nlm.nih.gov/articles/PMC5815012
Disability and Rehabilitation, 2026. Dasdemir et al. The effect of combined platelet-rich plasma andexercise on pain and function in knee osteoarthritis, a systematic review and meta-analysis of randomisedcontrolled trials. https://pubmed.ncbi.nlm.nih.gov/42188836/
Published London clinic price list for Arthrosamid, accessed September 2026.
Central London clinic price lists for image guided PRP and steroid injections, accessed September 2026.
This article is for general information and does not replace a medical assessment. Speak to one of our doctorsbefore deciding which injection, if any, is right for your knee.
Reviewed by [GMC-REGISTERED DOCTOR NAME, GMC NUMBER TO CONFIRM], The London PRP Clinic byThe Wellness. Last updated September 2026.
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