Knee ozone therapy (intra-articular ozone) is a local ozone treatment in which an ozone-oxygen mixture is injected directly into the knee joint through a fine needle. It is commonly called an “ozone injection”. In knee osteoarthritis, randomised trials report short-term improvement in pain and joint function; because most of these trials carry a risk of bias, the results are interpreted with caution 12.
I am a specialist in anaesthesiology and reanimation. I have practised ozone since 2010, and since 2019 with a Ministry of Health certificate. On this page I explain where ozone stands in the knee, how it relates to corticosteroid and the other intra-articular injections, and what the literature says. The general framework of ozone is on the ozone therapy page; the framework of options for the knee is on the pain treatment page.
How does it work in the knee?
The mixture injected into the joint comes into contact with the joint fluid and the joint lining; ozone quickly turns into oxygen and short-lived compounds. The effect of ozone is a controlled oxidative stimulus: this stimulus strengthens the body’s own antioxidant defences 3. Its effect on inflammatory signalling and antioxidant balance inside the joint has mostly been examined in experimental studies 4. In osteoarthritis, inflammation of the joint lining also contributes to pain; that inflammation is ozone’s target, not restoring worn cartilage.
When do I consider it?
The situations I assess in my practice: mild-to-moderate pain in early and moderate knee osteoarthritis; pain management after meniscus or ligament strain in cases that do not need surgery; joint complaints after sport. In an advanced knee that needs a surgical opinion, injection does not replace surgery. In inflammatory joint disease (rheumatological conditions) I decide together with rheumatology.
What I consistently observe in clinical practice is a reduction in pain and restricted movement; I write this as experience, not as a promise. I do not keep a patient who needs surgery for advanced osteoarthritis waiting on injections.
How it relates to corticosteroid, autologous serum, hyaluronic acid and PRP
There is no single injection for the knee; the decision depends on the joint’s phase and the goal.
Intra-articular corticosteroid injection has its place in knee osteoarthritis; the American College of Rheumatology’s 2026 update gives it a strong recommendation in the knee and rates the certainty of evidence as low 5. In a knee that needs frequent repeat injections, I instead assess serum produced from the patient’s own blood. I plan intra-articular ozone in this picture during the phase when pain and swelling are mild to moderate, on its own or in sequence with the other injections.
In the knee, the decision depends on the goal: when intra-articular inflammation is pronounced, autologous serum comes to the fore; in mild-to-moderate pain and within a broader ozone plan, intra-articular ozone does. The final choice is made at consultation.
Serum prepared from the patient’s own blood is explained on the Sanakin for knee osteoarthritis page, and intra-articular hyaluronic acid, which aims to support the lubricating quality of the joint fluid, on its own page. Ozone is not given in the same session as medical PRP or hyaluronic acid; they can be planned in sequence when needed, and I decide at consultation which comes first. I do not rank the injections against each other.
Being honest about the level of evidence
Randomised trials of intra-articular ozone in knee osteoarthritis have been assessed in a systematic review; improvement in pain and function was reported in the short and medium term, but because most trials had methodological problems and a risk of bias, the review noted that conclusions in comparison with other treatments are limited 1. In a double-blind placebo-controlled trial, pain and function scores in the ozone group were significantly better than placebo in the short term 2. Randomised trials comparing intra-articular ozone with corticosteroid injection have been pooled in a meta-analysis; none of these trials was judged to be at low risk of bias, and the authors state that definitive conclusions cannot be drawn 4. The American College of Rheumatology’s 2026 guideline summary contains no recommendation on intra-articular ozone; the same update recommends strongly against PRP and conditionally against hyaluronic acid in the knee 5. A long-term effect and an effect on cartilage have not been shown; I do not say “it repairs cartilage”. Alongside studies reporting improvement there are studies reporting limited benefit; I do not give unsourced percentages.
The procedure and pain management
Topical anaesthetic cream is standard. Because I am an anaesthesiologist, I treat pain management as a separate part of the procedure.
In an intra-articular injection, what you feel is a brief sting followed by a mild feeling of fullness.
Aftercare
Same day
- Walking is fine
First 24–48 hours
- Avoid running, squatting, frequent stair use and heavy loads
- No hot showers, sauna or hammam for 48 hours
Expected findings Mild pain, a feeling of fullness and slight swelling may occur for 1–2 days; brief cold application is enough. If swelling increases markedly, or redness or fever develops, contact the clinic.
Safety and anatomy
Because allergic reactions can occur rarely, treatments are carried out under medical supervision.
Sterile technique is used for intra-articular injection; the risk of infection is low but not zero.
Legal framework: In Türkiye, ozone therapy is performed by certified physicians within the framework of the Traditional and Complementary Medicine (GETAT) Regulation. My clinic is routinely inspected by the district health directorate of the Ministry of Health and is inspected separately under its health tourism authorisation certificate. The products I use are recorded.
Who is not suitable
Treatment is not performed, or is postponed, in the following situations:
- Active infection or inflammation in the treatment area
- Autoimmune disease in an active phase
- Pregnancy and breastfeeding
- Known hypersensitivity to the product components
- Uncontrolled chronic illness
- Untreated bleeding disorder or unregulated anticoagulant use
I do not perform these treatments during active cancer treatment. For a person with a history of cancer, I make the decision together with the treating specialist.
In intra-articular treatment, it is also not performed with an active joint or systemic infection or during a febrile illness; in the early period after an intra-articular steroid injection, the decision is made at consultation.
Without being a medical contraindication, I also consider expectation and treatment to be mismatched in these situations:
- People with advanced osteoarthritis who need surgery — an injection does not replace surgery
- People with undiagnosed, new or changing knee pain — a diagnosis comes first
- People expecting a lasting result from a single session
Suitability is determined by consultation in every case.
Pricing
Under the applicable regulations, price information cannot be published on our website. The cost of a treatment depends on the product used, the technique chosen and the extent of the treatment. You can call the clinic for detailed information.
Frequently asked questions
I’ve been told “the fluid in my knee has run out” — can knee ozone fix that?
What is commonly called “running out of joint fluid” is osteoarthritis. Knee ozone does not replace joint fluid; it targets inflammation of the joint lining and pain. If lubrication support is the aim, intra-articular hyaluronic acid is assessed separately.
How does knee ozone differ from a cortisone injection?
Cortisone is a strong anti-inflammatory medicine; the American College of Rheumatology’s 2026 update gives intra-articular cortisone a strong recommendation in knee osteoarthritis. Knee ozone acts through a controlled oxidative stimulus and does not appear in that guideline’s summary. Trials comparing the two have been assessed in a meta-analysis, but their quality was not sufficient for definitive conclusions. In a knee that needs frequent repeat injections, I make the decision at consultation.
Does knee ozone postpone surgery?
It aims at pain management in early and moderate osteoarthritis; in an advanced knee that needs surgery, injection does not replace surgery. I do not keep a patient who needs surgery waiting on injections.
Can knee ozone be combined with PRP or hyaluronic acid?
Not in the same session; they can be planned in sequence when needed. I decide at consultation which comes first.
Planning your visit
My clinic is in Nişantaşı, Şişli, on the European side of Istanbul, approximately 45 minutes from Istanbul Airport.
For knee ozone therapy I suggest planning a stay of two to three days: arrival, consultation and treatment, and departure. Because this treatment may be planned as more than one session, it may require more than one visit. The first session takes place in Istanbul, and we plan the schedule of any following sessions together according to your travel arrangements, with remote follow-up in between. Flying is generally appropriate 24 hours after an injectable treatment.
Consultations are conducted in English. Follow-up after you return home is arranged remotely, and I remain reachable for any questions during the period in which the result develops.
You can read how I offer this treatment at my clinic, IV Point, on the ozone therapy page.
Dr. Ömer Fatih Şahin — Specialist in Anaesthesiology and Reanimation Diploma Registration No: 113606 Ozone Therapy Certificate — Republic of Türkiye Ministry of Health, 2019
Published: 22 February 2026 · Last updated: 2026-09-22 This content has been medically reviewed by Dr. Ömer Fatih Şahin.
References
- Sconza C, Respizzi S, Virelli L, et al. Oxygen–ozone therapy for the treatment of knee osteoarthritis: a systematic review of randomized controlled trials. Arthroscopy. 2020;36(1):277–286. https://pubmed.ncbi.nlm.nih.gov/31679646/
- Lopes de Jesus CC, dos Santos FC, de Jesus LMOB, et al. Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: a randomized, double-blinded, placebo-controlled study. PLoS One. 2017;12(7):e0179185. https://pubmed.ncbi.nlm.nih.gov/28738079/ — 2024 correction (PLoS One 19(11):e0314494): the placebo and treatment groups were swapped in one table; the conclusion did not change.
- Bocci V, Borrelli E, Travagli V, Zanardi I. The ozone paradox: ozone is a strong oxidant as well as a medical drug. Med Res Rev. 2009;29(4):646–682. https://pubmed.ncbi.nlm.nih.gov/19260079/
- Arias-Vázquez PI, Castillo-Avila RG, Hernández-Gil K, Guzzardo MN, Guzzardo DR. Ozone injections reduce pain in knee osteoarthritis: a systematic review and meta-analysis. Med Gas Res. 2026;16(3):286–292. https://pubmed.ncbi.nlm.nih.gov/41496305/
- American College of Rheumatology. 2026 Update of the American College of Rheumatology Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (guideline summary). 14 September 2026. https://rheumatology.org/osteoarthritis-guideline