How do cortisone and stem cell injections differ?
The comparison of stem cells vs cortisone injections comes down to speed, duration and evidence. A cortisone shot is a corticosteroid injection, a strong anti-inflammatory medicine placed directly into a joint or around a tendon. It works within days and has been used for decades. The NHS explains how steroid injections work.
A stem cell injection delivers mesenchymal stromal cells, usually from fat, bone marrow or umbilical cord tissue, into the joint. These cells release signalling molecules that may calm inflammation and influence the joint environment over weeks to months. It is a regenerative medicine approach, not a drug.
Side-by-side comparison
| Cortisone (steroid) injection | Stem cell injection | |
|---|---|---|
| What it is | Corticosteroid medicine, often mixed with local anaesthetic | Mesenchymal stromal cells prepared in a laboratory |
| How it works | Rapidly suppresses inflammation | Signalling (paracrine) effects on inflammation and repair |
| Onset of relief | Days | Gradual, over weeks to months |
| Typical duration | Weeks to a few months | Uncertain; some studies follow benefit to 12 months or longer |
| Evidence | Strong for short-term relief | Moderate and mixed for knee osteoarthritis; early for other joints |
| Repeat use | Limited, as repeated use may harm tissue | Programs vary; long-term data limited |
| Main risks | Post-injection flare, raised blood sugar, skin thinning, rare infection | Pain flare and swelling, rare infection, harvest-site bruising |
| Approval (US/UK/AU) | Standard care | Not approved outside trials |
| Cost level | Low | Higher; depends on the program |
What does the evidence say about cortisone?
Cortisone injections give reliable short-term pain relief in knee osteoarthritis and are recommended as an option for flare-ups by the UK’s NICE guideline on osteoarthritis. The limitation is duration and repeat use. A two-year randomised trial found that steroid injections into the knee every three months led to slightly greater cartilage loss than saline, with no difference in pain (McAlindon et al., JAMA 2017). This is why doctors usually limit how often the same joint is injected.
What does the evidence say about stem cells?
Randomised trials and meta-analyses of mesenchymal stromal cell injections in knee osteoarthritis report improved pain and function in some patients, but study quality and results vary (PubMed search of trials). Direct comparisons with cortisone are few (PubMed search). Benefit, when seen, appears mainly in symptoms rather than clear cartilage regrowth. For hips, shoulders and other joints, the evidence is earlier still.
Can you switch from cortisone to stem cells?
Many people consider stem cells after cortisone injections have stopped working or the relief has become shorter each time. Switching is generally possible. Because steroids are designed to suppress cell activity and inflammation, doctors usually recommend a gap of several weeks between a cortisone injection and a cell-based injection; the exact interval varies between doctors and is not firmly established by research. Bring the dates and drugs of all previous injections to your consultation.
It also works the other way: having a stem cell or PRP injection does not rule out cortisone later for a flare-up, or a joint replacement if the arthritis progresses. A doctor can help plan the order so options are not closed off.
Which joints and conditions are relevant?
Both injections are used for knee osteoarthritis and hip osteoarthritis. Cortisone is also common for frozen shoulder and hip bursitis. For tendon problems such as tennis elbow, cortisone can give short-term relief but may be linked to poorer longer-term outcomes, which is one reason PRP therapy is often considered instead. Compare biologic options in stem cells vs PRP.
Who may be better suited to cortisone?
- A painful flare-up that needs fast relief.
- Inflammatory joint swelling, such as in rheumatoid arthritis, under specialist care.
- Bursitis or frozen shoulder where short-term relief helps rehabilitation.
- People who want a low-cost, well-established option and have not had frequent previous injections.
Who may be better suited to stem cells?
- Imaging-confirmed mild to moderate osteoarthritis (often Kellgren-Lawrence grade 2 to 3).
- Cortisone has stopped helping or only helps for a short time.
- People who want to limit repeated steroid exposure or delay surgery.
- People who accept that benefit is uncertain and may be partial.
Who should NOT have either injection?
- Active infection in or near the joint, or elsewhere in the body.
- Suspected fracture or joint infection that has not been ruled out.
- Severe end-stage arthritis, where joint replacement is usually more effective. See stem cells vs knee replacement.
- For cortisone: poorly controlled diabetes needs caution, as blood sugar can rise for several days.
- For stem cells: active cancer, certain blood disorders and pregnancy.
Risks and side effects
Cortisone can cause a short “steroid flare” of pain, facial flushing, temporary rises in blood sugar, and, with repeated injections, thinning of skin, fat or tendon near the injection site. Stem cell injections commonly cause swelling and stiffness for a few days, and collecting cells from fat or bone marrow can cause bruising. Infection is rare but serious with any joint injection. Cells are prepared in ISO 9001:2015-certified partner laboratories, and injections are performed under ultrasound guidance.
Conventional options come first
Before any injection, the foundation of joint care is exercise therapy, weight management and pain relief. The NHS describes osteoarthritis treatment, including physiotherapy and when surgery may help. Injections work best as part of a rehabilitation plan, not on their own.
Find out which option suits you
- Send your knee or joint X-ray or MRI on WhatsApp, with the dates of any previous injections.
- A Thai Medical Council-licensed doctor reviews your stage and history.
- You get honest advice: continue conventional care, consider cortisone at home, a regenerative program, or a surgical opinion.
Read how it works, or our guides for patients from Australia, the UK and the US.
Frequently asked questions
Is a stem cell injection better than a cortisone shot?
It depends on the goal. Cortisone works faster and has strong evidence for short-term relief. Stem cell injections are slower and less proven but are studied for longer-lasting benefit in mild to moderate osteoarthritis. Few trials compare them directly.
How long does a cortisone injection last in the knee?
Relief commonly lasts from a few weeks to a few months and varies between people. Benefit tends to fade over time, which is why repeated injections are often discussed and limited.
Do cortisone injections damage cartilage?
One randomised trial found that injecting the knee with steroid every three months for two years led to slightly more cartilage loss than saline, without better pain control. Occasional injections are still widely used and considered acceptable.
Can I have stem cells after a cortisone injection?
Usually yes, but doctors generally recommend waiting several weeks after a steroid injection before a cell-based injection, because steroids may affect cell activity. Tell your doctor the date of your last injection.
How many cortisone shots can I have in a year?
Doctors commonly limit injections into the same joint to a few per year, spaced at least several weeks apart, to reduce side effects. Your doctor will advise based on your joint and health.
How much do stem cell knee injections cost compared with cortisone?
Cortisone injections are generally inexpensive. Stem cell programs have no fixed price because the plan depends on your diagnosis. Send your MRI on WhatsApp for a free doctor review and a personalised program.
This page is general information, not medical advice, and does not replace a consultation with your own doctor. Results vary and no treatment outcome can be guaranteed. We are a patient coordination service and may receive a referral fee from partner medical providers. See our medical disclaimer and referral disclosure.