Overview
Injection options range from traditional to biological. Steroid injections offer effective pain relief but have fallen out of favour for routine use, as they can accelerate cartilage breakdown and bring forward the need for joint replacement — though they still have a role in severe OA where surgery carries high risk. Hyaluronic acid injections provide lubrication and cushioning, offering reliable symptomatic relief without altering disease progression. PRP (platelet-rich plasma) has emerged as the leading joint-preservation option, using the patient's own concentrated platelets to reduce inflammation, support cartilage health, and slow OA progression — proving more effective than both steroid and hyaluronic acid injections in early-to-moderate disease (Grade I–III), though it isn't suitable once cartilage loss is severe (Grade IV). Arthrosamid, a single-dose, non-biodegradable hydrogel injection, is a newer addition to the options available — integrating into the joint's synovial tissue to reduce pain.
The Procedures
Steroid Injections
The orthopaedic community has been using steroid injections for decades, and this still has a role to play. However, steroids have been shown to upregulate MMPs and their action, causing them to work harder and break down the cartilage even faster. This then in fact accelerates OA and results in joint replacement surgery much earlier than necessary.
Mr Barkatali tries to avoid the use of steroid injections where possible. However, steroids can be effective for pain relief in severe OA and inflammatory conditions when joint replacement surgery may be too high risk.
Hyaluronic acid
Hyaluronic acid injections have been used for many decades to help treat joint and musculoskeletal problems.
Hyaluronic acid injections are an effective method of treating knee joint pain and OA. These work by providing a lubricant and cushioning effect in the knee joint as well nourishing the cartilage.
Types available:
- Ostenil
- Ostenil Plus
- Durolane
- Synvisc / Synvisc one
Cingal
Cingal offers a considered option for patients with painful knee osteoarthritis. Cingal is a fast-acting viscosupplement injection therapy, combining an established corticosteroid with a high-concentration, cross-linked hyaluronic acid in a single treatment. It works within the first week for most patients, sometimes within 48 hours, and its effects can continue for up to six months, according to the strongest level of clinical evidence available. By calming inflammation quickly, Cingal clears the way for the hyaluronic acid to work more effectively, helping patients return to physiotherapy and an active lifestyle sooner. It's particularly suited to athletes and active people needing fast relief, as well as those who prefer a single-visit treatment without repeat top-up injections. Cingal can also be a valuable option for patients with more severe osteoarthritis who have been advised towards knee replacement, helping to safely extend time with their natural joint while staying active.
PRP
PRP has emerged as a leading joint-preservation treatment for osteoarthritis, backed by a growing body of clinical evidence. These platelets contain growth factors that stimulate healing, reduce inflammation, and improve function — and, crucially, help slow the progression of OA by downregulating the enzymes (MMPs) responsible for cartilage breakdown, while supporting healthier chondrocyte function and cartilage matrix production. Research shows PRP to be more effective than both steroid and hyaluronic acid injections, and it's generally considered safe, with rare reported side effects.
PRP is best suited to early, mild, and moderate OA (Grade I–III), where it can meaningfully delay or even prevent the need for major surgery — but it isn't effective once joint changes become severe (Grade IV). Beyond OA, PRP is also used to treat patellar and quads tendinitis, ligament sprains, and muscle strains. That said, it isn't a guaranteed fix for everyone — results vary, and several treatments may be needed to see meaningful improvement — so it's worth discussing your individual case with your surgeon to determine whether PRP is the right option for you.
What to expect on the day
Treatment consists of a course of three injections spaced over six weeks, ideally around two weeks apart, though timing can be adjusted to fit around other commitments. Each session takes place in the clinic: once you're confirmed eligible for treatment and have discussed the risks and benefits as part of the consent process, a small blood sample is taken from your arm. This is spun in a specialised centrifuge to separate and concentrate the platelets, which are then injected directly into the affected joint or around the painful tendon.
Outcomes
- 20+ years of experience
- 5000+ operations
- <1% complication rate
Healing Begins Here
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5*
<1%
5000+
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“Since the PRP in both knees last year I have had super amazing results.
Back running again and been able to dance (a new found hobby) to replace doing iron man’s. I am sure it’s nice for Bilal to hear this news - and ever grateful for his expertise in NOT going down the surgery route. It seems patience and mindfulness and rehab and PRP was indeed the correct protocol for me”
Shelly, Course of PRP in 2025, aged 61.
