Sanakin for Knee Osteoarthritis

Sanakin is known colloquially as “smart plasma”: an autologous cytokine-rich serum treatment in which the patient’s own blood is incubated in a special tube to enrich it with anti-inflammatory proteins, then injected into the joint. In knee osteoarthritis I consider it in the active phase, when pain and swelling are in the foreground, for patients in whom I do not want to repeat corticosteroid injections frequently. I perform the intra-articular injection as an anaesthesiologist and plan pain control as part of the procedure.

This page covers the knee only. How Sanakin is prepared, how it works and its other uses are on the Sanakin (smart plasma) page; the overall framework of the methods I use for pain is on the pain treatment page.

What produces pain in the knee?

In osteoarthritis, worn cartilage is not the only source of pain; cartilage itself has no pain nerves. Pain comes from inflammation of the joint lining (synovium), from the bone beneath the cartilage, from ligaments and menisci, and from the muscles around the joint. So in the picture patients describe as “my knee has run out of fluid”, I first separate which structure is producing the pain and which phase the joint is in: active inflammation (pain, swelling, warmth, morning stiffness), or settled wear that causes friction and stiffness?

Method class by type of problem

In the knee, the decision depends on the state of the joint: in the active phase, when pain and swelling are the main issue, serum prepared from the patient’s own blood comes to the fore; once inflammation has settled and lubrication support is wanted, intra-articular hyaluronic acid does. They are not given in the same session; when needed they are planned in sequence. The final choice is made at consultation.

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 ². In a knee that needs frequent repeat injections, I instead assess serum produced from the patient’s own blood.

In treatments prepared from your own blood, the decision depends on the goal: when inflammation and redness are in the foreground, the serum enriched in anti-inflammatory proteins comes to the fore; when tissue stimulation and revitalisation are the aim, platelet-rich plasma does. The final choice is made at consultation.

The same logic applies to intra-articular ozone:

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.

Intra-articular ozone is explained on its own page: knee ozone therapy.

How does it work?

Blood is incubated at body temperature in a special tube containing glass beads; the literature reports that during this time leucocytes produce interleukin-1 receptor antagonist (IL-1Ra) and other anti-inflammatory cytokines ¹. IL-1 is one of the carriers of the inflammatory signal in osteoarthritis. The separated serum is injected into the joint; no steroid or other drug is added.

Honesty about the level of evidence matters here. For this class, a randomised trial in knee osteoarthritis with placebo and hyaluronic acid controls reported improvement in pain and function scores; that trial used a different product — the class is the same, the product is not — and is linked to the manufacturer ³. Against this, an independent meta-analysis of the randomised trials of this class found no significant difference in pain or function scores at six months compared with saline, with high inconsistency between trials and low certainty of evidence; the authors state that the current data are not sufficient to support this treatment ¹.

The current guideline does not name this product class; in the knee it recommends conditionally against treatments aimed at suppressing the IL-1 pathway ² — and the mechanism described for Sanakin rests on that pathway. I say this to the patient and we decide together. In a knee that needs frequent repeat injections I assess this serum instead of corticosteroid; that is a preference, not a proven advantage. I do not say “it halts cartilage breakdown” or “it protects the joint”, and I do not give unsourced percentages.

When do I consider it?

• Early and intermediate knee osteoarthritis: in the active phase, when pain and swelling are in the foreground. In advanced disease, with bone rubbing on bone, the goal is pain management only, and I say so from the start.
• Pain management in degenerative meniscus tears that do not require surgery — in my clinical practice, in patients who have had an orthopaedic assessment.
• Pain behind the kneecap (chondromalacia patellae) — in my clinical practice, in selected patients.

In advanced osteoarthritis I do not keep a patient who needs surgery waiting with injections; I assess early and intermediate stages. For undiagnosed knee pain I ask for imaging and, where needed, an orthopaedic opinion first.

The process and session plan

1. Blood draw: about 5 minutes; blood is taken into a special Sanakin tube.
2. Preparation: 3 hours. You may leave the clinic during this time.
3. Injection: about 10 minutes; the prepared serum is injected into the joint.

• 1–3 sessions; the number depends on the state of the joint and the response to the first session.
• Hyaluronic acid is not given in the same session; it can be planned in a separate session after the Sanakin course.
• The preparation process is detailed on the hub page.

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.

Safety and anatomy

The serum is prepared from the patient’s own blood in a sterile closed system; no drug is added. Sterile technique is essential for intra-articular injection; the risk of infection is low but not zero — which is why you should contact the clinic if swelling increases markedly or redness or fever develops after the procedure. Mild pain and a feeling of fullness for 1–2 days after injection are normal. In randomised trials, complication rates were similar to placebo injection and serious complications were rarely reported ¹. Because allergic reactions can occur rarely, treatments are carried out under medical supervision.

Product status: This product class consists of products assessed within the scope of CE and TİTCK for the relevant indications. Because the serum is prepared from the person’s own blood, it is not a medicine but a preparation system within the scope of medical devices.

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.

Treatment is not performed with an active joint or systemic infection or during a febrile illness; with haematological disease and 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 expecting a lasting result from a single session
• People with undiagnosed knee pain — a diagnosis comes first
• People with advanced osteoarthritis who need surgery — an injection does not replace surgery

Suitability is determined by consultation in every case.

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.

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

How is Sanakin different from a cortisone shot?

Corticosteroid is a synthetic drug; it gives rapid, short-term control in a severe flare and carries a strong recommendation in the knee in the current guideline. Sanakin is prepared from your own blood, contains no drug and aims to reduce the inflammatory signal with the natural proteins in the serum; the evidence for this class, however, is limited. In a knee that needs frequent repeat injections I assess this serum instead of corticosteroid, and we make the decision together at consultation.

How many Sanakin sessions are needed for the knee?

Usually 1–3. The number depends on the state of the joint and the response to the first session; I do not promise a permanent result from a single session.

Can Sanakin delay knee replacement surgery?

In early and intermediate stages it can push back the need for surgery by improving pain and function; I do not say it “eliminates” the need, because there is no evidence to show that. In advanced disease, with bone rubbing on bone, the goal is pain management only, and I do not keep a patient who needs surgery waiting with injections.

At which stage of knee osteoarthritis is Sanakin used?

In early and intermediate osteoarthritis, in the active phase when pain and swelling are in the foreground. In advanced disease it may be considered for pain management; it does not restore tissue.

Planning your visit

My clinic is in Nişantaşı, Şişli, on the European side of Istanbul, approximately 45 minutes from Istanbul Airport.

For Sanakin knee treatment 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.

Dr. Ömer Fatih Şahin — Specialist in Anaesthesiology and Reanimation Diploma Registration No: 113606

Published: 22 February 2026 · Last updated: 2026-09-21 This content has been medically reviewed by Dr. Ömer Fatih Şahin.

References

1. Curtis A, Beswick A, Jenkins L, Whitehouse M. Is there a role for autologous conditioned serum injections in osteoarthritis? A systematic review and meta-analysis of randomised controlled trials. Osteoarthritis Cartilage. 2024;32(10):1197–1206. https://pubmed.ncbi.nlm.nih.gov/38878817/
2. 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
3. Baltzer AWA, Moser C, Jansen SA, Krauspe R. Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis. Osteoarthritis Cartilage. 2009;17(2):152–160. https://pubmed.ncbi.nlm.nih.gov/18674932/ — The trial used a different product of the same class and is linked to the manufacturer.