Ultrasound-Guided Knee Injections for Osteoarthritis: Cortisone, HA, PRP, and Arthrosamid
Notes on procedural naturopathic medicine.
Knee osteoarthritis pain can stick around even when you’re doing the right things. If you’re considering an injection, here is a clear map of the ultrasound-guided options I discuss in clinic — cortisone, hyaluronic acid (Cingal or Durolane), PRP, and Arthrosamid — and why placement under ultrasound matters.
In my practice, those injections are done with a Mindray MX7 at Tall Tree Cordova Bay. Guidance is about where the treatment goes, not a promise of how you’ll feel afterward. No injection reverses osteoarthritis; the options differ in what they are and how long relief may last.
What these injectables actually are
Think of these as different tools, not a ranked list.
Cortisone
Often discussed when inflammation is driving a lot of the symptoms and shorter-term relief is the goal. Guidelines don’t all sound identical on timing and trade-offs. The useful conversation is whether that trade-off fits your knee and timeline.
Hyaluronic acid (viscosupplementation)
These products are meant to support joint lubrication and viscoelasticity. Brands I use include Cingal and Durolane. Some guidelines are more supportive of hyaluronic acid than others. Product choice — if any — depends on your history, goals, and how prior treatments went.
PRP (platelet-rich plasma)
PRP concentrates platelets from your own blood. Preparation methods vary widely, and major OA guidelines do not all agree on whether to recommend it. If PRP is on the table, ask how it would be prepared and how that fits the current evidence.
Arthrosamid
Arthrosamid is a hydrogel option I discuss in clinic for some people with knee OA. Manufacturer materials describe roughly 2.5% cross-linked polyacrylamide and 97.5% water, usually framed as a single knee injection (often discussed as 6 mL). I use that manufacturer detail so you know what the product is made of and how it’s typically given — whether it’s appropriate for you is a consult decision.
Published research on this hydrogel class includes longer follow-up after one injection and a comparison with hyaluronic acid. Those findings are group averages. Individual results vary, and suitability needs a clinical assessment.
How they differ in conversation
| Cortisone | Hyaluronic acid | PRP | Arthrosamid | |
|---|---|---|---|---|
| What it is | Anti-inflammatory medicine | Viscosupplement | Your own platelet concentrate | Hydrogel discussed as integrating with the joint lining |
| Typical frame | Shorter-term relief | Medium-term support | Biologic / regenerative; prep-dependent | Single injection; longer-horizon discussion in published follow-ups |
| Repeats | Often time-limited courses | Product-dependent | Protocol-dependent | Manufacturer notes repeat dosing has not been studied the same way as the single-dose work |
This table is a teaching aid — not a ranking. The right next step, if any, depends on imaging, what you have already tried, other health factors, and what you want to get back to.
Questions worth bringing to a consult
- Given my imaging and exam, where do injectables sit next to physio, bracing, meds, or surgery timing?
- For my knee, what are the real trade-offs among cortisone, HA, PRP, and a hydrogel option like Arthrosamid?
- Will this be ultrasound-guided — and why does that matter for the option we are discussing?
- What does the evidence say for my stage of OA — and what does it not say?
- What does recovery look like after the specific option we choose?
I provide clinical care for these procedures in British Columbia only, through booked consults at Tall Tree Cordova Bay.
Soft next step
If you are in BC and want to talk through whether an ultrasound-guided knee injectable is appropriate for you:
Book US-guided injection — Tall Tree Cordova Bay
A precision practice · naturalwellnesswithsyd.com · @dr.sydgreen
Sources
- Fang WH, et al. Ultrasound vs landmark guidance in OA — systematic review and meta-analysis of RCTs. Australas J Ultrasound Med. https://pmc.ncbi.nlm.nih.gov/articles/PMC11109994/
- Ultrasound-guided knee injection accuracy — Level I RCT review. Arthrosc Sports Med Rehabil. https://doi.org/10.1016/j.asmr.2021.01.028
- Bannuru RR, et al. OARSI guidelines for non-surgical management of knee, hip, and polyarticular OA. Osteoarthritis Cartilage. 2019. https://doi.org/10.1016/j.joca.2019.06.011
- Injection-based management of knee OA — guideline review. Front Pharmacol. https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.661805/full
- Bliddal H, et al. 2.5% iPAAG — 5-year extension. J Orthop Surg Res. https://pmc.ncbi.nlm.nih.gov/articles/PMC12817702/
- Bliddal H, et al. Polyacrylamide gel vs hyaluronic acid for knee OA — RCT. Clin Exp Rheumatol. 2024. https://doi.org/10.55563/clinexprheumatol/i3fqee
- Contura — Arthrosamid SSCP (composition / single 6 mL framing). https://contura.com/wp-content/uploads/2025/11/018.SSCP_.00023.03-v001-Arthrosamid_final_for-upload-to-webpage.pdf
- Contura — Arthrosamid IFU. https://contura.com/wp-content/uploads/2025/11/05_8252680_NY_Arthrosamid-10117-001-_72x215_okt2025_forside.pdf
Disclaimer
This content is general educational information, not medical advice, and not a substitute for individualized care from your own qualified provider. Dr. Sydney Green, ND provides clinical care only to patients within British Columbia.