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Non-Surgical Treatment

Joint Injections

Non-surgical treatment options for knee and hip osteoarthritis — platelet-rich plasma (PRP) and hyaluronic acid viscosupplementation.

Biologic & Viscosupplement Therapy

Injection Treatments

For patients with mild-to-moderate osteoarthritis, injection therapy can provide meaningful pain relief, improve joint function, and delay or avoid the need for surgery.

Platelet-Rich Plasma (PRP)

Autologous growth factor therapy — using your own blood

PRP is prepared from a small sample of your own blood. After centrifugation, platelets are concentrated to create a solution rich in growth factors and anti-inflammatory proteins. This autologous preparation is injected directly into the affected joint to stimulate tissue repair, reduce inflammation, and improve joint environment.

What It Is
Autologous platelet concentrate derived from the patient's own blood. No synthetic agents. No risk of allergic reaction to foreign material.
Indications
Mild-to-moderate knee osteoarthritis (Kellgren-Lawrence Grade 1–3), hip osteoarthritis, early joint degeneration, and patients seeking to delay surgical intervention.
Procedure
Blood draw (15–30 mL) → centrifuge (approx. 15 minutes) → injection into joint. Ultrasound or fluoroscopic guidance used as appropriate for accuracy.
Number of Injections
Typically 1–3 sessions, spaced 4–6 weeks apart. Individualized based on response.
Pain Relief Onset
4–8 weeks. PRP is not an immediate analgesic — it stimulates a biological healing response that takes time to develop.
Duration of Effect
6–12 months in good responders. Variable by patient age, BMI, and arthritis severity.
Evidence Level
Grade B evidence for knee osteoarthritis. Supports PRP as superior to saline and comparable to hyaluronic acid in multiple RCTs and meta-analyses.
OHIP Coverage
Not covered by OHIP — private pay. Please contact the office for current pricing information.

Hyaluronic Acid (Viscosupplementation)

Restoring joint lubrication with a natural joint component

Hyaluronic acid (HA) is a naturally occurring molecule in healthy joint fluid, providing lubrication and shock absorption. In osteoarthritis, HA concentration and molecular weight decrease — leading to reduced joint protection. Viscosupplementation replaces this degraded HA, restoring the viscoelastic properties of joint fluid.

What It Is
Purified hyaluronic acid — a natural component of joint synovial fluid. Available as pharmaceutical-grade injection preparations.
Products Used
Synvisc (Genzyme), Durolane (Bioventus), Monovisc — single or multi-injection formulations selected based on patient preference and clinical factors.
Indications
Knee osteoarthritis (Kellgren-Lawrence Grade 1–3). Patients who have not adequately responded to physiotherapy, NSAIDs, or corticosteroids and wish to delay surgery.
Injection Series
1 injection (single-dose HA products like Durolane or Synvisc), depending on the product selected.
Duration of Relief
3–6 months on average. Some patients experience up to 12 months of benefit. May be repeated if the first course was effective.
How It Works
Restores joint fluid viscoelasticity, reducing friction and improving mechanical joint environment. May also have direct anti-inflammatory effects.
OHIP Coverage
Not covered by OHIP — private pay. Extended health benefits (through employer or private insurance) may cover viscosupplementation — check with your insurer.
Patient Selection

Who Is a Candidate?

Injection therapy is most appropriate for patients with mild-to-moderate osteoarthritis who meet specific clinical criteria.

Good Candidates

  • ✓ Mild-to-moderate osteoarthritis (Kellgren-Lawrence Grade 1–3 on X-ray)
  • ✓ Patients who want to delay or avoid joint replacement surgery
  • ✓ Active individuals or athletes with early joint degeneration
  • ✓ Patients not yet ready for surgery due to age, fitness, or personal preference
  • ✓ Those who have had a partial response to physiotherapy, NSAIDs, or corticosteroids
  • ✓ Patients who are not ideal surgical candidates due to medical comorbidities

Less Likely to Benefit

  • – End-stage arthritis with severe bone-on-bone changes (K-L Grade 4) — surgery likely more appropriate
  • – Active joint infection or skin infection overlying the injection site
  • – Patients who have previously had no response to multiple injection courses
  • – Active inflammatory arthropathy during disease flare (rheumatoid arthritis, gout)
  • – Certain bleeding disorders or patients on anticoagulation (discuss with Dr. Watts)
Procedure Experience

What to Expect

A step-by-step overview of the injection process — before, during, and after your appointment.

Before Your Appointment

  • No special fasting is required for joint injections
  • Continue your regular medications unless otherwise instructed — if you take blood thinners (warfarin, apixaban, rivaroxaban), inform the office in advance
  • Wear loose, comfortable clothing that allows easy access to the knee or hip
  • Arrange transportation home — you can typically drive yourself for knee injections, but may wish to have someone drive after a hip injection
  • Bring your health card and any relevant imaging (X-rays, MRI) if you have them

During the Procedure

  • For PRP: a small blood sample (15–30 mL) is drawn from your arm, then processed in a centrifuge for approximately 15 minutes to concentrate the platelets
  • The skin over the joint is cleaned with antiseptic solution
  • A local anaesthetic may be applied or injected to minimize discomfort
  • The injection is administered directly into the joint — image guidance (ultrasound or fluoroscopy) may be used to ensure accurate placement
  • The procedure typically takes 20–30 minutes in total
  • You may feel mild pressure or a brief sting — most patients tolerate the procedure well

After the Injection

  • Ice, not heat: Apply ice to the injected area for 15–20 minutes, several times on the day of the injection to minimize post-injection soreness
  • Rest the day of injection: Avoid strenuous activity, heavy exercise, or prolonged walking on the injection day
  • Mild soreness and swelling around the injection site is normal for 24–48 hours — this is an expected inflammatory response
  • Resume normal, gentle activity the following day unless otherwise instructed
  • Avoid anti-inflammatory medications (NSAIDs such as ibuprofen, naproxen) for 2 weeks after a PRP injection, as they may reduce PRP's effectiveness
  • PRP: allow 4–8 weeks before assessing the full benefit. Viscosupplementation: some patients notice improvement within 2–4 weeks
  • Contact the office if you experience significant increased pain, marked swelling, fever, or any concerns following the procedure
Side by Side

PRP vs. Viscosupplementation

A quick reference comparison to help you understand the key differences between the two injection options.

PRP
Viscosupplementation
Source
Patient's own blood
Pharmaceutical HA
Mechanism
Growth factors + anti-inflammatory
Restores joint lubrication
Injections
1–3 sessions (4–6 wks apart)
1–3 (product-dependent)
Onset of Relief
4–8 weeks
2–4 weeks
Duration
6–12 months
3–12 months
Evidence
Grade B — knee OA
Established — knee OA
OHIP Coverage
Not covered
Not covered (check private insurance)
Non-Surgical Options

Book a Consultation

Not sure whether PRP, viscosupplementation, or surgical management is right for you? Dr. Watts will review your imaging, assess your joint, and recommend the most appropriate treatment plan for your individual situation.

Referrals accepted through the OJAC at Markham Stouffville Hospital — contact the office at 905-472-3374.

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