Stem Cells vs Cortisone for Knee Arthritis: What the Research Says

If you have knee osteoarthritis, you have probably heard two very different pitches: a cortisone shot that your primary doctor can give you this week, or a regenerative injection that a specialty clinic says could “regrow” cartilage. Both claims deserve a closer look. Rather than guessing, it helps to know what a large, controlled clinical trial actually found when the two approaches went head-to-head — and what that means for how you weigh your options with a physician.

The two treatments, in plain terms

A cortisone (corticosteroid) injection reduces inflammation inside the joint. It is fast, inexpensive to administer in a routine office visit, and has decades of use behind it, but the anti-inflammatory effect is temporary and repeated injections over time have been linked to cartilage thinning in some studies.

Stem cell joint regeneration uses a concentrated preparation of cells to modulate inflammation and support the joint’s healing environment. At Utah Stem Cells, the cells used come from donated umbilical cord and amniotic tissue — screened, laboratory-processed allogeneic material — not cells taken from the patient’s own bone marrow or fat. This distinction matters because “stem cell therapy” is not one single product; the source and processing method vary widely between clinics and research trials.

Many patients also ask about PRP joint treatment, which is different again: platelet-rich plasma is autologous, meaning it is drawn from the patient’s own blood and re-injected after concentration. PRP and donor-derived stem cell therapy are sometimes used together as part of a broader plan for joint pain.

What the MILES trial actually measured

The most relevant head-to-head evidence comes from the Multicenter Trial of Stem Cell Therapy for Osteoarthritis, known as MILES. It was a single-blinded, randomized controlled trial run at four research sites with 480 participants who had varying degrees of knee osteoarthritis. Participants were assigned to one of four groups: autologous bone-marrow-derived mesenchymal stem cells, autologous stromal vascular fraction cells (from fat tissue), allogeneic umbilical cord tissue-derived cells, or a corticosteroid injection used as the control.

At one year, researchers found that all four groups reported an equivalent level of pain improvement, tracked through self-reported pain scores, functional questionnaires, and MRI imaging. That is a notable finding for two reasons. First, it means the umbilical cord-derived cell group — the type of allogeneic, donor-tissue approach used at Utah Stem Cells — performed on par with corticosteroids in this trial. Second, it challenged the assumption that cortisone only helps for a few months; in MILES, the corticosteroid group’s relief held up for the full year of follow-up, longer than some earlier studies had suggested.

The trial’s principal investigator was careful to note that neither treatment is a cure-all, and that the biological, MRI-documented changes some patients showed do not guarantee that pain relief will scale the same way for everyone. Safety data from MSC injections in the trial showed no serious adverse reactions. A three-year follow-up and subgroup analysis by osteoarthritis severity are still being reviewed, so longer-term comparisons are not yet final.

So which one is “better”?

Based on this trial, neither option is a knockout winner on pain relief alone at the one-year mark. Where they tend to differ is in what else they offer:

• Onset and mechanism: Cortisone acts quickly by damping inflammation but does not address the joint’s underlying biology. Regenerative injections work more gradually and are intended to support the joint environment rather than simply suppress a flare.
• Injection frequency: Cortisone is often limited to a small number of injections per year because of concerns about cartilage effects with repeated use. Regenerative protocols are typically approached as a more considered, less frequent intervention, decided case by case.
• Source and safety profile: Because Utah Stem Cells uses donor-derived umbilical and amniotic tissue rather than tissue harvested from the patient’s own bone marrow or fat, there is no surgical harvesting procedure involved — the material arrives pre-processed under laboratory screening standards.

None of this means one approach automatically replaces the other. Many patients use corticosteroid injections earlier in their osteoarthritis course and consider regenerative options as their symptoms progress, or use both in a coordinated way under a physician’s guidance. If you have already tried stem cells for knee pain and are weighing your next step, or you are comparing PRP vs stem cells for joint pain for the first time, the honest answer is that the right sequence depends on your imaging, symptom pattern, and prior treatment history.

Who tends to be a candidate

People considering either option are usually dealing with joint pain and stiffness from osteoarthritis that has not fully responded to conservative measures such as physical therapy, weight management, or over-the-counter anti-inflammatories. Candidacy for a regenerative approach also depends on:

• The severity of joint space narrowing seen on imaging
• Whether other joints or systemic autoimmune conditions are involved
• Prior response (or lack of response) to corticosteroid injections
• Overall health goals — for example, wanting to delay or avoid knee replacement surgery

Regenerative therapy is not FDA-approved as a cure for osteoarthritis, and it is not right for every patient. A physician evaluation, including a review of your imaging and treatment history, is the only reliable way to know whether you are a reasonable candidate.

What to expect from a consultation at Utah Stem Cells

Dr. William Cimikoski’s approach starts with an honest conversation about what the evidence does and does not show — including trials like MILES — rather than a sales pitch. That typically includes a review of your knee imaging, a discussion of prior treatments (including cortisone, if you’ve had it), and a candid assessment of whether an allogeneic, donor-tissue injection, PRP, or a combination fits your situation. You can read more about the broader landscape of options in our overview of stem cell research on knee osteoarthritis and the benefits of stem cell therapy for knees.

Frequently asked questions

Is stem cell therapy proven to work better than cortisone for knee arthritis?

The best available head-to-head trial (MILES) found equivalent pain improvement between corticosteroid injections and several stem cell approaches at one year. Neither was clearly superior on pain scores alone, and results vary by individual.

Does Utah Stem Cells use the patient’s own stem cells?

No. Utah Stem Cells uses allogeneic cells sourced from donated, laboratory-screened umbilical cord and amniotic tissue — not cells harvested from your own bone marrow or fat. PRP, when used alongside regenerative injections, is autologous and comes from your own blood.

How long does cortisone relief last compared to stem cell injections?

Cortisone has traditionally been described as offering relief for a few months, though the MILES trial found its effect lasted a full year in that study population. Regenerative injections are also intended to provide longer-term support, but individual duration of benefit varies and is not guaranteed.

Can I combine cortisone and stem cell or PRP treatment?

Some patients use corticosteroids earlier in their disease course and consider regenerative options later, or combine PRP with a donor-tissue injection. Whether combining or sequencing treatments makes sense for you is a decision for your physician based on your specific case.

Is this treatment a cure for knee osteoarthritis?

No. Regenerative injections are not an FDA-approved cure for osteoarthritis. They are intended to help manage symptoms and support joint health, and outcomes vary from patient to patient.

Will insurance cover the visit or the injection?

Coverage varies by insurer and by the specific service, so this is best discussed directly with our office and your insurance provider during scheduling rather than assumed from a general article.

This article is for general education and does not constitute medical advice or a guarantee of any particular outcome. Regenerative and corticosteroid treatments for knee osteoarthritis are not a substitute for an individualized evaluation by a licensed physician, and results vary between patients. No treatment described here is an FDA-approved cure for osteoarthritis. Please consult Dr. William Cimikoski or another qualified provider to discuss whether these options are appropriate for you.