Hyaluronic Acid vs. PRP vs. Cortisone — A Complete Comparison
Author: Dr. Alexandru Grecu — Senior Orthopedic and Trauma Surgeon
Published: 18 aprilie 2026 · Reviewed: 2 mai 2026
Three Injections, Three Different Mechanisms
"Which is better—hyaluronic acid or PRP? And what about cortisone?" This is the question I get most often. Each treatment has a different role, and the choice depends on the diagnosis and stage.
Hyaluronic Acid—The Joint Lubricant
What it is: a natural substance in synovial fluid, administered by direct injection.
How it works: restores the viscosity of the synovial fluid, reduces friction, and cushions impact.
Best results: stage II-III knee osteoarthritis. Can also be used for the hip, shoulder, and ankle.
Protocol: 1 injection or 3 injections one week apart. Repeated every 6-12 months.
Takes effect in: 10-14 days. Lasts: 6-12 months.
Advantages: well-studied, predictable effect, excellent tolerance.
Limitations: does not repair or regenerate. Does not work in stage IV.
PRP—The Biological Growth Factor
What it is: plasma enriched with platelets from your own blood.
How it works: platelets release growth factors that stimulate regeneration and reduce inflammation.
Best results: chronic tendinopathies, stage I-III osteoarthritis, muscle injuries.
Protocol: 1-3 sessions 2-4 weeks apart.
Takes effect in: 2-4 weeks. Lasts: months.
Advantages: made from the patient's own blood, minimal allergy risk.
Limitations: results vary between individuals.
Cortisone—The Inflammation Firefighter
What it is: a synthetic corticosteroid injected into the joint.
How it works: quickly and powerfully reduces inflammation. It does not repair, regenerate, or lubricate—it just puts out the fire.
Best results: acute inflammation episodes, bursitis, acute tendinitis.
Protocol: a single injection. Maximum of 3-4 per year in the same joint.
Takes effect in: 24-72 hours (fast!). Lasts: 4-8 weeks (temporary).
Advantages: rapid effect, useful in acute crises.
Limitations: NOT for long-term use—repeated doses can accelerate cartilage degradation.
When to Use Each—A Practical Summary
- Stage II-III osteoarthritis, chronic pain: Hyaluronic acid ± PRP
- Chronic tendinopathy: PRP
- Acute crisis: Cortisone, followed by HA or PRP
- Stage IV osteoarthritis: neither provides sustained relief → joint replacement
Can they be combined?
Yes. A common strategy: 1) Cortisone in the acute phase, 2) PRP or HA after 2-4 weeks, 3) Physical therapy in parallel.
For context, see the dedicated page on PRP injections, and if you want to go deeper, read abouthow PRP therapy works and abouthyaluronic acid injections.