Summary
With over four million Canadians facing osteoarthritis, in many cases, joint care is shifting to preservation before major surgery. Options like cortisone, Toradol, Hyaluronic Acid, PRP, Prolotherapy, and multi-year Arthrosamid® hydrogel offer varied pain relief, duration, and safety profiles, though provincial Medicare coverage varies significantly across treatments.
I was catching up with a group of friends last Saturday night when the topic turned to joint and back pain. A couple of my friends were sharing their frustration with persistent back agony caused by a variety of issues.
Aside from my concern for my friends, what interested me about the conversation was how care differed so radically for each woman. One friend’s care team had discussed non-surgical options at length with her, while the other had already spoken with an orthopaedic surgeon, and for her, surgery was presented as the only option.
As it turns out, many Canadians are walking this pathway.
According to Arthritis Society Canada and the Public Health Agency of Canada, around 4 million Canadians (about 1 in 7 adults) currently live with osteoarthritis. That number is projected to climb to over 6 million in the coming years. Painful knees make up the vast majority of these cases, and over half of all Canadians living with osteoarthritis are under the age of 65.
These are active people in the prime of their lives who need real solutions now. For many, this may mean major orthopedic surgery, however joint care and a focus on joint preservation is rapidly evolving, with injections at the forefront.
Decoding the Injection Options: Where and Why They Work
If you step inside a modern sports medicine or interventional pain clinic, you’ll discover that joint injections have come a long way. They are no longer a “one-size-fits-all” treatment. Instead, they fall into three main categories based on how they work, where they are used on the body, and how long they last.
1. Cortisone (Corticosteroids)
- Where on the Body: Almost anywhere. They are used in the knees, hips, shoulders, ankles, elbows, wrists, and even the spine (facet joint or epidural injections for lower back pain).
- Why It Works: Cortisone is a powerful, synthetic anti-inflammatory hormone. It acts like a fire extinguisher: when a joint is red-hot, swollen, and severely inflamed, cortisone rapidly shuts down the chemical pain signals and flushes out joint fluid buildup.
- How Fast & How Long: Works within 24 to 72 hours, providing relief that typically lasts 3 to 12 weeks.
- The Catch: Cortisone is a quick fix, not a permanent repair. The risks of cortisone shots are not insignificant and because high doses of steroids can actually weaken cartilage, tendons, and surrounding tissues over time, doctors strictly limit cortisone shots to 3 or 4 times a year per joint.
- The Cost: The medical procedure of administering a medically necessary corticosteroid (cortisone) injection by a physician is generally covered by provincial health insurance plans. You may need to pay out-of-pocket or via private/extended health insurance unless you qualify for public drug coverage programs (such as seniors aged 65+, youth under 25 via OHIP+, or social assistance recipients). The cost ranges widely from $15 to $400+ per injection, depending heavily on where you receive the shot and whether or not you have private insurance.
- Who Should Avoid: Cortisone injections should be avoided by anyone with an active infection, a known allergy, or uncontrolled diabetes.
2. Intra-Articular NSAIDs (Toradol / Ketorolac)
- Where on the Body: Knees, shoulders, and hips.
- Why It Works: Ketorolac (Toradol) is a concentrated liquid anti-inflammatory (NSAID) injected directly into the joint space. It cools down localized inflammation much like taking oral ibuprofen, but without stomach upset.
- Duration: Relief lasts 2 to 6 weeks.
- The Catch: Unlike cortisone, intra-articular Toradol does not damage joint cartilage, making it a safer option for frequent use or for diabetic patients who cannot tolerate cortisone-induced blood sugar spikes.
- The Cost: The doctor’s time to evaluate you and administer the injection is paid for by Medicare. The drug itself is covered if you have public prescription coverage (such as OHIP+, Ontario Drug Benefit for seniors, or provincial drug plans), or through standard private insurance. Otherwise, it is a very minor out-of-pocket expense, typically $10 to $30.
- Who Should Avoid: People with a history of severe allergic reactions to aspirin or other NSAIDs, active bleeding disorders, or severe kidney disease should avoid intra-articular ketorolac (Toradol) injections. Additionally, pregnant women, particularly past 30 weeks of pregnancy and patients undergoing or who are scheduled for coronary artery bypass graft (CABG) surgery should also avoid this treatment.
3. Hyaluronic Acid (Viscosupplementation)
- Where on the Body: Synovial (fluid-filled) joints, primarily the knees, hips, and shoulders. Generally not used for structural spinal back pain or disc issues, or in smaller joints such as fingers.
- Why It Works: Healthy joints naturally produce a thick fluid containing hyaluronic acid that acts like shock-absorbing motor oil. As osteoarthritis sets in, this fluid thins out, causing bone to rub against bone. Injecting a gel-like hyaluronic acid re-lubricates the joint space so bones glide smoothly without grinding.
- How Fast & How Long: Takes 2 to 5 weeks to build up full relief, lasting 6 to 12 months.
- The Catch: Because hyaluronic acid is a natural component of your body’s joint fluid, it is safe and does not damage cartilage, and your body naturally breaks down the gel over time. To maintain relief, you must get re-injected every year or so.
- The Cost: Viscosupplementation injections in Canada typically range from $250 to $800 CAD per treatment or syringe, depending on the brand of hyaluronic acid, the clinic, and whether an injection or image-guidance fee is included.
- Who Should Avoid: Hyaluronic acid (HA) injections should not be given to individuals with active joint infections, skin infections near the injection site, or known allergies to HA products. Additionally, major clinical guidelines generally do not recommend them for patients with severe, advanced “bone-on-bone” osteoarthritis, as the lack of remaining cartilage makes the treatment ineffective.
4. Arthrosamid® Hydrogel
- Where on the Body: Currently Health Canada-approved exclusively for knee osteoarthritis.
- Why It Works: Arthrosamid is a breakthrough hydrogel made of 97.5% water and 2.5% polyacrylamide. Unlike hyaluronic acid, it is non-biodegradable, meaning your body cannot break it down. When injected into the knee, the gel permanently blends into the inner lining of the joint capsule (the synovium). It creates a thick, flexible cushion that absorbs shock and reduces friction every time you take a step.
- How Fast & How Long: Relief develops gradually over 2 to 6 weeks, with clinical trials showing continuous pain reduction lasting 2 to 5+ years from a single injection.
- The Cost: It is a novel, premium therapy available primarily in private clinics, costing approximately $3,500 to $4,500 CAD per knee.
- Who Should Avoid: Individuals with known allergies to polyacrylamide or related substances, and those with active infections, bleeding disorders, or certain immune conditions should avoid Arthrosamid injections. People who have a knee replacement or other foreign body/implants in the knee, or those who had knee arthroscopy within the past 6 months should also avoid it. Pregnant and breastfeeding women should defer the treatment as safety has not yet been established.
- Where on the Body: Knees, hips, shoulders, elbows (tennis elbow), and tendons (Achilles).
- Why It Works: PRP uses your body’s own blood. A small blood sample is drawn, spun in a centrifuge to concentrate growth factors and platelets, and injected back into the injured joint or tendon. These growth factors calm biological inflammation and stimulate tissue healing.
- Duration: Relief typically builds gradually and lasts 9 to 18 months.
- The Catch: Requires 1 to 3 initial injection sessions. Because it relies on your body’s natural healing response, results can vary based on age and overall health. Provincial health plans across Canada treat PRP as an elective/experimental therapy and do not cover it. Expect to pay $600 to $1,200 per session at private sports medicine clinics. Most basic extended health drug plans do not cover PRP, however, some patients can successfully claim a portion of the cost through a Healthcare Spending Account (HSA) or specialized wellness benefits.
- Who Should Avoid: People with active infections, severe anemia, blood disorders, regular NSAID users, pregnant women, or those with certain systemic diseases should avoid Platelet-Rich Plasma (PRP) joint injections.
6. Prolotherapy
- Where on the Body: Tendons, ligaments, knees, lower back, and hips, especially useful where loose ligaments cause joint instability.
- Why It Works: Prolotherapy uses a concentrated sugar-water (dextrose) solution injected into weak ligaments or joint capsules. The mild irritant triggers a localized, natural healing response, causing the body to lay down new collagen fibers and tighten loose joints.
- Duration: Often requires 3 to 6 sessions spaced a few weeks apart, but results can be long-lasting once collagen strengthens.
- The Catch: It causes temporary soreness for 24–48 hours after each session as the healing response activates. The dextrose (sugar water) solution and the procedure itself are not covered by provincial health plans. Expect to pay $150 to $300 per session (usually requires 3 to 6 sessions for full effect). It is rarely covered under standard drug benefits, but it’s frequently eligible for reimbursement through Health Spending Accounts (HSAs).
- Who Should Avoid: Individuals with active local or systemic infections, pregnant women (especially in the first trimester), bleeding disorders, or known allergies to injection components should avoid prolotherapy.
Side-by-Side Joint Treatment Comparison
Compare speed, duration, safety, target areas, and Canadian healthcare coverage for non-surgical joint therapies.
| Treatment | Category | Speed of Relief | Typical Duration | Cartilage Safety | Primary Body Areas | Cost & Canadian Coverage |
|---|---|---|---|---|---|---|
| Cortisone | Steroid | Fast (1–3 days) | 3–12 weeks | Risk of wear with repeat use | All joints & spine | Doctor Covered by Medicare Drug Cost: $15–$400+ out-of-pocket (unless covered via OHIP+, ODB for seniors 65+, or private drug plan). |
| Toradol | Non-Steroid | Fast (1–3 days) | 2–6 weeks | Safe / Non-damaging | Knees, shoulders, hips | Doctor Covered by Medicare Drug Cost: $10–$30 minor fee (covered if you have public or private drug coverage). |
| Hyaluronic Acid | Lubricant Gel | Moderate (2–4 wks) | 6–12 months | Safe / Non-damaging | Knees, hips, shoulders | Not Covered by Medicare Cost: $300–$600 per joint (often covered by extended private benefits). |
| Arthrosamid® | Permanent Hydrogel | Moderate (2–6 wks) | 2 to 5+ years | Safe / Non-damaging | Knees only | Not Covered by Medicare Cost: $3,500–$4,500 per knee. |
| PRP Therapy | Biologic | Gradual (3–6 wks) | 9–18 months | Promotes tissue repair | Knees, shoulders, tendons | Not Covered by Medicare Cost: $600–$1,200 per session. |
| Prolotherapy | Dextrose / Sugar | Cumulative | Long-term | Safe / Non-damaging | Ligaments, spine, knees | Not Covered by Medicare Cost: $150–$300 per session. |
The Surgeon Spectrum: Why Practices Differ
Hearing my friend’s story Saturday night highlighted a reality in Canadian healthcare: not all orthopedic specialists practice the same way.
1. The Surgical Specialist
Many orthopedic surgeons in Canada’s public healthcare system are dedicated surgical specialists. Their primary mandate within public hospitals is performing surgeries, repairing torn ligaments or replacing failing joints. If a patient’s knee isn’t quite severe enough for a $20,000 artificial joint replacement, a surgical specialist may simply tell the patient to wait, as ongoing non-surgical joint management falls outside their operating-room focus.
2. The Joint Preservation Specialist
On the other side of the spectrum are Sports Medicine physicians, interventional pain doctors, and non-surgical orthopedic specialists. Their core focus is joint preservation, using every tool available to keep your natural joint functioning as comfortably as possible for as long as possible.
Some orthopedic surgeons (such as mine) have their own sports orthopedic clinics outside and alongside a hospital setting. If you find one like this, you can get a real bang for your buck as they can help with joint preservation but also be there when and if you do finally need surgery.
3. The Public vs. Private Coverage Reality
Canadian provincial health plans (like OHIP in Ontario, MSP in BC, or AHS in Alberta) cover hospital visits, surgeries, and basic cortisone injections. However, public health insurance generally does not cover advanced gels like hyaluronic acid or Arthrosamid. These modern therapies are offered through private sports medicine clinics, not in a hospital setting.
Who Should You Work With to Find Your Solution?
If you want to explore non-surgical options for your joints, navigating the healthcare system effectively requires partnering with the right provider:
- Family Doctor / General Practitioner (GP): Start here to get up-to-date, weight-bearing X-rays or MRIs of your joint. Ask your GP for a direct referral to a Sports Medicine Clinic or a doctor specializing in joint preservation.
- Sports Medicine Physicians: These doctors specialize in non-surgical joint care. They use real-time ultrasound imaging to place injections precisely where they belong inside the joint capsule.
- Interventional Pain Specialists: Ideal if your primary complaint involves back/spine pain, hips, or nerve-related joint pain that requires fluoroscopic (X-ray guided) precision.
- Orthopedic Surgeons with a Joint Preservation Focus: Look for surgeons who offer interventional non-surgical options alongside traditional surgical procedures.
For some people, it’s viable to explore alternatives before going under the knife. Whether you need a quick cortisone shot to calm a painful flare-up, annual hyaluronic acid injections to keep your hips or shoulders moving smoothly, or a long-lasting hydrogel cushion like Arthrosamid to protect your knees, it’s soothing to know that a roadmap exists.
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