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Comparison of Stem Cell Injections and Lubricants for Knee Arthritis Treatment
By: Terry L. Whipple, MD
Osteoarthritis of the knee affects approximately 12.1% of adults in the United States, with women experiencing it slightly more often than men. Common symptoms include pain, swelling, stiffness, and impaired knee function.
There has long been debate over the best approach to treating symptomatic osteoarthritis—also known as degenerative arthritis. Over the years, treatment options have evolved from rest and heat therapy to anti-inflammatory medications, physical therapy, joint injections, and, ultimately, total knee replacement surgery.
This article provides the latest insights into injection-based therapies for knee osteoarthritis.
The Evolution of Injection Therapy
For decades, anti-inflammatory oral medications have been used to treat knee arthritis. However, because these drugs travel through the digestive system and bloodstream, their effects can be diluted, and they may cause unwanted side effects. To bypass this issue, steroid injections were introduced, delivering anti-inflammatory treatment directly to the inflamed knee joint.
While steroid injections provided temporary relief, frequent use was found to weaken cartilage, potentially accelerating joint degeneration. This led to the development of lubricant injections designed to mimic natural joint fluid and reduce friction within the knee. These lubricants, primarily composed of hyaluronic acid (HA), aimed to improve movement and relieve pain.
Stem Cell Therapy: A New Approach
The advent of stem cell therapy introduced a promising alternative. Stem cells, known for their ability to develop into different types of human cells, opened the possibility of cartilage repair in arthritic knees.
Stem cells can be harvested from various sources, including:
- Bone marrow
- Fat tissue
- Umbilical cord blood
- Peripheral blood (although in lower quantities)
Peripheral blood is particularly notable because it contains platelets rich in growth factors, which enhance cartilage repair. Despite the lower concentration of stem cells, this method is more accessible and cost-effective compared to bone marrow or fat-derived stem cell extraction.
Which Treatment Is More Effective?
Several studies have compared the effectiveness of stem cell injections versus HA lubricant injections for treating knee osteoarthritis. However, results have been inconclusive, with no definitive answer—until recently.
In February 2025, a major review was published in Arthroscopy, The Journal of Arthroscopic and Related Surgery. The study analyzed 818 patients with knee osteoarthritis who received either:
- Hyaluronic Acid (HA) lubricant injections
- Stem cell injections (from any of the previously mentioned sources)
Patients were evaluated at 3, 6, and 12 months post-treatment, based on:
- Pain relief (self-reported)
- Knee functionality
- Imaging studies of cartilage repair
Key Findings:
✅ Stem cell injections showed significantly superior results in pain reduction, knee function, and cartilage repair compared to HA lubricant injections.
✅ Adverse reactions (such as mild swelling and injection-site pain) were similar in both treatment groups.
Our Preferred Approach at Whipple Knee Clinic
Based on these findings, our preferred treatment for mild to moderate knee osteoarthritis is the use of peripheral blood stem cell injections, combined with platelet-rich plasma (PRP) to enhance growth factor availability.
Of course, individual cases may vary, and specific circumstances might warrant alternative treatments. However, scientific evidence strongly supports stem cell therapy as the superior choice for patients seeking relief from knee arthritis while promoting long-term joint health.
Reference:
Jin W, Yin L, Sun H, Zhao Z, Yan X. Mesenchymal Stem Cells Injection is More Effective Than Hyaluronic Acid Injection in the Treatment of Knee Osteoarthritis with Similar Safety: A Systematic Review and Meta-Analysis. Arthroscopy, 2025; 41: 318-332.