For patients in Kuwait with knee osteoarthritis, one of the most common questions is whether cortisone injections, hyaluronic acid injections, or surgery is the most appropriate next step.

There is no single treatment that is right for every patient. The choice depends on the severity of osteoarthritis, pain level, mobility, X-ray findings, previous treatments, general health, activity goals, and how much the symptoms affect daily life.

Patients in Kuwait can be evaluated by Dr. Muthana Sartawi at New Mowasat Hospital in Salmiya, where he is listed as a Consultant Orthopedic Surgeon within the international visiting physicians program. Because visiting schedules may change, patients should confirm current appointment availability before attending. Official New Mowasat Hospital profile.

Patients can also review the Joint Replacement Guide for Patients from Kuwait on Dr. Sartawi’s website for additional information about orthopedic evaluation and treatment options.

Why Are Knee Injections Used?

Knee osteoarthritis develops when the structures inside the joint undergo gradual degenerative changes. Symptoms may include pain, stiffness, swelling, reduced movement, and difficulty walking or carrying out daily activities.

Before considering knee replacement, many patients may be treated with non-surgical options such as physiotherapy, exercise, weight management when needed, medication, activity modification, and certain types of knee injections.

Receiving an injection does not automatically mean that surgery will never be needed in the future. Injections can instead be used as part of a broader treatment plan to control symptoms and preserve function.

Dr. Sartawi’s website also discusses conservative treatment options, including knee injections, before joint replacement is considered.

Cortisone Injections for Knee Osteoarthritis

Cortisone, or intra-articular corticosteroid injection, is injected directly into the knee joint with the aim of reducing inflammation and relieving symptoms.

The American Academy of Orthopaedic Surgeons states that intra-articular corticosteroid injections can provide short-term symptom relief for patients with knee osteoarthritis. AAOS Clinical Practice Guideline on Knee Osteoarthritis.

NICE also states that corticosteroid injections may be considered when other pharmacological treatments are ineffective or unsuitable, or when short-term symptom relief may help a patient participate in therapeutic exercise. NICE describes the expected benefit as generally short term, approximately 2 to 10 weeks. NICE Osteoarthritis Recommendations.

Who May Benefit from Cortisone Injections?

Cortisone injections may be considered when a patient has:

• Painful knee osteoarthritis.

• An inflammatory flare with increased pain or swelling.

• Difficulty participating in physiotherapy because of pain.

• Symptoms that have not responded adequately to other appropriate conservative treatments.

• A need for temporary symptom control while a longer-term treatment plan is being determined.

The decision should be individualized after examination of the knee and review of medical imaging and the patient’s medical history.

Does Cortisone Treat Knee Osteoarthritis?

No.

A cortisone injection may reduce inflammation and pain, but it does not reverse existing osteoarthritis or regenerate lost joint cartilage.

Patients should therefore distinguish between symptom relief and treatment of structural damage inside the joint.

If severe osteoarthritis continues to affect walking, sleep, work, or normal daily activities despite appropriate conservative treatment, the orthopedic surgeon may begin discussing surgical options.

Are Cortisone Injections Safe for Everyone?

Not necessarily.

A patient’s health status and medication history should be reviewed before an injection. For example, corticosteroid injections can temporarily affect blood glucose levels, which is particularly important for patients with diabetes.

Patients should inform the orthopedic team about diabetes, medications, blood thinners, previous injections, allergies, infections, and any other relevant medical conditions before treatment.

The treating physician should also determine the number and frequency of injections, and they should not be repeated without medical supervision.

What Are Hyaluronic Acid Injections for the Knee?

Hyaluronic acid injections, sometimes called intra-articular viscosupplementation, involve injecting a substance designed to resemble some components of the natural fluid found inside the joint.

Patients may sometimes hear these injections informally described as “gel injections” or “lubricating injections.”

The proposed aim is to improve joint lubrication and reduce symptoms. However, the evidence supporting routine use is less strong than some patients may expect.

What Do Current Guidelines Say About Hyaluronic Acid?

This is an important point for patients comparing injection options.

The AAOS clinical guideline states that intra-articular hyaluronic acid injections are not recommended for routine use in patients with symptomatic knee osteoarthritis. AAOS Guideline PDF.

NICE also recommends not offering intra-articular hyaluronan injections for osteoarthritis based on its assessment of the available evidence. NICE Recommendations.

This does not mean that no physician ever uses hyaluronic acid injections. It means that major evidence-based guidelines do not support their routine use for every patient with knee osteoarthritis.

The orthopedic surgeon may discuss available options with the patient according to the diagnosis, previous treatments, expectations, and the available evidence.

Cortisone vs Hyaluronic Acid: What Is the Difference?

Therefore, the more important question is not simply “Which injection is better?” but rather “What is causing my symptoms, how advanced is my osteoarthritis, and which treatment is appropriate for my current stage?”

When Might Injections No Longer Be Enough?

Injections may become less useful when osteoarthritis progresses to the point where pain and loss of function remain severe despite appropriate non-surgical treatment.

Signs that conservative treatment may no longer be providing enough improvement can include:

• Persistent pain that clearly affects daily life.

• Difficulty walking even short distances.

• Major difficulty climbing stairs.

• Night pain or pain at rest.

• Progressively increasing stiffness or deformity.

• Reduced independence in daily activities.

• Insufficient improvement despite physiotherapy, medication, activity modification, and other appropriate treatments.

Surgery should not be recommended simply because an X-ray shows osteoarthritis. The patient’s symptoms, function, clinical examination, medical imaging, general health, and personal goals should all be taken into account.

Dr. Sartawi’s Kuwait-specific content also explains that having osteoarthritis does not mean every patient needs joint replacement. Surgical treatment is generally discussed when previous treatments no longer provide sufficient improvement and pain or reduced mobility significantly affects daily activity.

When Is Knee Replacement Considered?

Knee replacement may be considered for patients with advanced symptomatic osteoarthritis when appropriate non-surgical treatment does not provide sufficient relief.

Depending on the pattern of damage inside the knee, the orthopedic surgeon may discuss total or partial joint replacement.

Total Knee Replacement

Total knee replacement may be appropriate when osteoarthritis affects several areas of the knee and the patient’s symptoms and examination findings support this option.

Patients can review additional information about preparing for and recovering from knee replacement surgery on Dr. Sartawi’s website. Guide Before and After Knee Replacement Surgery.

Injections or Surgery: How Is the Decision Made?

There should not be an automatic sequence of cortisone → hyaluronic acid → surgery.

Treatment should instead be based on each patient’s individual condition.

The orthopedic surgeon may consider:

• Severity and location of osteoarthritis.

• Severity and duration of pain.

• Walking ability and daily function.

• X-ray findings.

• Previous response to medication or injections.

• History of physiotherapy.

• Knee alignment and stability.

• Age and general health.

• The patient’s activity expectations.

• Medical conditions that may influence treatment selection.

For some patients, conservative treatment remains appropriate.

For others, repeatedly relying on temporary treatments despite severe loss of function may delay a more definitive discussion about surgical treatment.

Should I Have Another Injection Before Considering Surgery?

Not automatically.

If a previous injection provided meaningful temporary improvement and the osteoarthritis remains manageable, another conservative option may sometimes be considered.

However, if symptoms are severe and the patient has already undergone appropriate non-surgical treatment without sufficient improvement, the orthopedic surgeon may recommend discussing surgical treatment rather than repeatedly relying on injections.

Patients should also inform the surgeon about all previous injections and their dates, especially when planning knee replacement surgery.

Orthopedic Evaluation in Kuwait

Patients can be evaluated in Kuwait at New Mowasat Hospital in Salmiya. The hospital lists Dr. Muthana Sartawi as a Consultant Orthopedic Surgeon and international visiting physician, and his areas of practice include knee replacement and rapid-recovery joint replacement. Official New Mowasat Hospital profile.

New Mowasat Hospital also provides orthopedic surgery, joint replacement, and sports medicine services, including knee and hip replacement, arthroscopy, and other musculoskeletal conditions. New Mowasat Orthopedic & Spine Surgery Center.

Because Dr. Sartawi’s visits to Kuwait are periodic, patients should confirm his current appointment schedule before attending.

To request an appointment in Kuwait, patients can contact Dr. Sartawi’s team via WhatsApp at +965 9474 7760 to request or arrange a consultation and confirm current clinic availability.

What Should Patients in Kuwait Bring to the Consultation?

A more complete evaluation can be performed when the patient brings:

• Recent knee X-rays.

• MRI or CT scans, if previously performed.

• Previous imaging reports.

• A current medication list.

• Information about previous cortisone or hyaluronic acid injections.

• Dates and outcomes of previous physiotherapy sessions.

• Reports from previous knee operations, if applicable.

• Information about diabetes, heart disease, blood thinners, allergies, and any other relevant medical conditions.

Patients can also review the guide on preparing medical records before orthopedic treatment planning in Kuwait.

Frequently Asked Questions

Which Is Better for Knee Osteoarthritis: Cortisone or Hyaluronic Acid?

There is no single answer that applies to everyone, but major current guidelines provide stronger support for short-term symptom relief with corticosteroid injections than for routine use of hyaluronic acid injections. AAOS does not recommend routine use of hyaluronic acid for knee osteoarthritis, while NICE recommends not offering it for osteoarthritis.

Does Hyaluronic Acid Rebuild Knee Cartilage?

No. Hyaluronic acid injections should not be presented as a treatment that regenerates lost cartilage or reverses advanced osteoarthritis.

Can Injections Prevent the Need for Knee Replacement?

They may help control symptoms in some selected patients, but they do not guarantee that knee replacement will never become necessary. Long-term treatment decisions depend on symptoms, function, osteoarthritis severity, and response to conservative treatment.

Does Having Knee Osteoarthritis Mean I Need Surgery?

No. Many patients with knee osteoarthritis can initially be treated without surgery. Knee replacement is generally considered when symptoms become severe and appropriate conservative treatment no longer provides sufficient improvement.

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