Hyaluronic Acid Injection For Joints And Tendons: Is It Useful
Arthritis and tendonitis is common in the general public. For those of us who are active in sport or running, arthritis and tendonitis can cause pain and swelling that stops us from taking part in these activities. Dr Masci has written a blog on effective treatments for arthritis. So, is a hyaluronic acid injection effective for arthritis and tendonitis?
Research Comparing Prp Bone Marrow And Adipose
A July 2020 study published in the journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, compared platelet-rich plasma , bone marrow aspirate concentrate, and adipose-derived mesenchymal stem cell injections in the treatment of osteoarthritis of the knee using functional scores.
- Methods: A total of 89 patients with painful knee osteoarthritis were included in this study.
- Patients were assigned to one of the 3 treatments according to the severity of osteoarthritis as indicated by symptoms and radiography to PRP , bone marrow aspirate concentrate , or adipose-derived MSC .
- Clinical assessment was performed using standard scoring systems, Surveys were completed at preoperative, and at 90, 180, and 265 days post-treatment.
Results: They all worked well.
- In a general statement, the PRP worked just as well in stage 1 knee osteoarthritis patients as the bone marrow aspirate worked in the stage 2 knee osteoarthritis patients and the adipose-derived stem cells worked for the stage 3 knee osteoarthritis patients. To quote the researchers: Our findings support previous reports and encourage further research on the use of these cost-effective treatments for osteoarthritis of the knee.
This is also a validation of our policy of not going straight to stem cell therapy in some of our patients. PRP or Prolotherapy, which is discussed below can provide equally good results without the added expense.
Do Injections Work For Knee Pain Don’t Waste Your Money
As spring turns into summer, we spend more time outdoors, exercising, gardening, or just walking around. And for many people, more exercise means knee pain. Count me among the afflicted.
Several people, including my orthopedic specialist, have suggested that I try injections of hyaluronic acid to treat my knee pain. Many people swear by it, and even though I looked into this two years ago , I thought I would look again. Perhaps the evidence had changed.
Superficially, these injections sound reasonable. Hyaluronic acid is already inside your knee and helps to lubricate and cushion the joint. Adding more lubricant seems like a good idea after all, it works for cars, bicycles, door hinges, or any other creaky joint.
But not for knees. Just recently, Anne Rutjes, Peter Jüni and their colleagues published a very large review of the evidence on knee injections. They looked at 89 trials involving over 12,000 adults and found that in the trials that were properly controlled , hyaluronic acid injections had either no effect or a clinically irrelevant effect that is, too small a difference to matter to the patient.
Rutjes and colleagues also pointed out that theres a real risk of harm when you inject something deep into the knee joint. To quote their summary for patients :
Viscosupplementation may provide little if no pain relief or function improvement in patients with knee osteoarthritis. It also seems to increase the risk for adverse events.
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Then Why Is Your Doctor Still Recommending This Treatment
Lets let Dr. Leopold continue:
One reason might be that surgeons have relatively few effective nonsurgical alternatives that help patients with their joint pain, andbeing members of a helping professionwe find this frustrating. However, our lack of effective nonsurgical treatments cannot justify the use of an ineffective one, and it must not be used to justify surgery unless surgery is indicated. Some patients will have pain that persists despite well-tested nonsurgical treatments, but not enough to warrant major joint surgery others may not fit the biopsychosocial profile that supports a decision to perform elective arthroplasty. The answer to this is not to use a treatment like viscosupplementation that studies suggest is ineffective, nor to take a chance on surgery when it seems ill-considered to do so, but rather to explain to patients that there are some problems for which we have no effective treatments, and to help those patients adjust and adapt.
Why Might I Need Viscosupplementation Treatment For Arthritis
You may have already tried other treatments for your arthritis, like over-the-counter pain medicines and corticosteroid injections. If you still have significant symptoms, viscosupplementation might be a good choice to help reduce your pain, stiffness, and swelling. The treatment seems to work best in people with mild or moderate arthritis. The treatment may particularly make sense if you are trying to delay getting surgery on your joint.
Generally, healthcare providers use viscosupplementation to treat osteoarthritis, but the technique may also benefit people with certain other kinds of arthritis, like rheumatoid arthritis. You can talk to your healthcare provider about whether it is a choice for your type of arthritis.
Hyaluronic acid injection is not a treatment choice for arthritis in all types of joints. The knee is the standard injection site, but you might also be able to get it for arthritis in your hip or possibly in another location.
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Knee Osteoarthritis And The Role Of Prp
Osteoarthritis involves a gradual loss of cartilage or cushioning from the ends of the bones in the knee. The cartilage gradually wears away, both for mechanical reasons , or the cartilage may wear away because of the hostile chemicals your knee produces when the arthritic process starts. When your knee hurts due to Osteoarthritis you will also notice swelling, clicking, and grinding. When the inflammation due to arthritis is severe you may also have pain at rest and at night.
Unfortunately, arthritis can not be reversed or cured. But many physicians have started offering their patients injections of PRP to treat their knee arthritis pain. Over the years there has been growing evidence that PRP can help moderate the pain of knee arthritis and improve your quality of life.
Patients Undergoing Treatment For Knee Osteoarthritis With Prp Can Be Expected To Experience Improved Clinical Outcomes When Compared With Hyaluronic Acid
There is a lot of research comparing PRP to hyaluronic acid. Here are some of the papers:
An April 2020 study led by the Department of Orthopedics, University of Colorado School of Medicine, published in The American Journal of Sports Medicine suggested: Patients undergoing treatment for knee osteoarthritis with PRP can be expected to experience improved clinical outcomes when compared with hyaluronic acid.
Doctors writing in the September 2019 issue of the World Journal of Orthopedics offered these findings in assessing PRP versus hyaluronic acid injections over four, eight, and twelve-week follow-ups after treatments.
- The effectiveness of PRP treatment in patients with knee osteoarthritis was significantly greater than in the hyaluronic acid group. In addition, two injections of PRP were more effective at each follow-up than a single injection.
In February 2020, a multi-national team of researchers published findings in the European Journal of Orthopaedic Surgery & Traumatology comparing intra-articular knee injection of PRP and hyaluronic acid and investigating clinical outcomes and pain at both 6 and 12 months.
- Here researchers examined 1,248 cases 636 PRP, 612 hyaluronic acids. The results of this systematic review and meta-analysis suggest that PRP is superior to hyaluronic acid for symptomatic knee pain at 6 and 12 months.
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Cortisone Can Make Bone On Bone Worse By Thinning Out The Meniscus But One Injection Appears Okay
One of the reasons that you are considering a knee replacement or are thinking about getting a cortisone injection is because you have been told you have a bone on bone knee. So the idea that cortisone may make this worse by thinning out your meniscus is concerning doctors.
In August of 2020 in the journal Scientific Reports doctors expressed concerns about damaging the meniscus tissue with cortisone injections. It should be noted that this researchs main findings were that it was okay to get one cortisone injection. For many people, one injection would be considered safe. Here are the learning points of that research:
- Although intra-articular corticosteroid injections are commonly used for the treatment of knee osteoarthritis, there is controversy regarding possible side effects on the knee joint structure.
- In this study, the effects of intra-articular corticosteroid injections on worsening the knee structure and creating greater pain were examined.
- Findings: No significant effect of the intra-articular corticosteroid injections were found on the rate of cartilage loss nor on any other knee structural changes or patient-reported pain scores. In conclusion, a single intra-articular corticosteroid injection for the treatment of osteoarthritis-related knee pain was shown to be safe with no negative impact on structural changes, but there was a transient meniscal thickness reduction, a phenomenon for which the clinical relevance is at present unknown.
The Current Literature Demonstrates The Potential Benefits Of Utilizing Concentrated Bone Marrow Aspirate For The Repair Of Cartilaginous Lesions Bony Defects And Tendon Injuries
Doctors in New Jersey at the Department of Orthopedic Surgery, Jersey City Medical Center published their findings in support of this research, in the World Journal of Orthopedics, here is what the paper said:
- The current literature demonstrates the potential benefits of utilizing concentrated bone marrow aspirate for the repair of cartilaginous lesions, bony defects, and tendon injuries in the clinical setting. The studies have demonstrated using concentrated bone marrow aspirate as an adjunctive procedure can result in cartilage healing similar to that of native hyaline tissue, faster time to bony union, and a lower rate of tendon re-rupture.
A June 2018 study in the journal Arthritis and Musculoskeletal Disorders presents the short-term progress of 15 patients with knee osteoarthritis through four bone marrow concentrate treatments.
- Patients underwent four bone marrow concentrate treatments on average 14 days after 1st treatment, 21 days after the second treatment, and 33 days after the third treatment. The last follow-up was conducted on an average of 86days after the first treatment.
Patients experienced statistically significant improvements in active pain and functionality scores after the first treatment.
- On average, patients experienced:
- an 84.31% decrease in resting pain,
- a 61.95% decrease in active pain,
- and a 55.68% increase in functionality score at the final follow-up.
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Hyaluronic Acid And Your Knees
In your knees, and your other joints, hyaluronic acid provides cushioning and lubrication. Your bones are protected and can move smoothly against each other when you extend or flex your knee. However, conditions like osteoarthritis wear away your cartilage and synovial lining, which leads to inflammation and pain.
Growth And Healing Factors In Prp This Is What Makes Prp Work
A paper in the journal Clinical Cases in Mineral and Bone Metabolism describes the growth, healing, and repair factors found in platelet-rich plasma. These are the healing factors and what they do:
- PDGF initiates connective tissue healing through the promotion of collagen and protein synthesis.
- The primary effect of PDGF seems to be its mitogenic activity to mesoderm-derived cells such as fibroblasts ,
- Vascular muscle cells .
- Glial cells and chondrocytes .
- The most important specific activity of PDGF is the creation of cartilage.
So the concept is here. These healing growth factors in your blood are taken and spun, to separate out a platelet-rich plasma solution filled with these healing and growth factors, and then the solution is injected into your knee.
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What Are The Side Effects Of Hyaluronic Acid Shots
The shots are usually low risk, but some side effects may occur. Typical side effects include pain, swelling, heat, redness, and/or fluid build-up around the knee, Dr. Miller says. Rest and ice afterward can help prevent the typical side effects.
More rarely, infections of the joint are possible, as is damage to other parts of the knee, he says. However, properly trained physicians will deliver an injection with very little risk of complications, Dr. Miller says.
Two Groups Of Patients One Group Gets Prp The Other Group Gets Cortisone How Did This Comparison Work Out
In this study from The Journal of Sports Medicine and Physical Fitness, a comparison is made between the effects of a one-time injection of PRP and corticosteroid for the patients suffering from osteoarthritis.
- Patients suffering from Grade II or Grade III knee osteoarthritis were randomly divided into two groups: intraarticular injection of PRP and cortisone.
- Forty-one participants were involved in the research .
Compared to the group treated with corticosteroid, PRP showed significant results for:
- pain relief
- being symptom-free
- activities of daily living and quality of life
This study demonstrated that one shot of PRP injection, decreased joint pain more and longer-term, alleviated the symptoms and enhanced the activity of daily living and quality of life in short-term duration in comparison with the corticosteroid.
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Another Use In Plantaris
Some cases of Achilles tendinopathy have a plantaris tendon interfering with the inside of the Achilles tendon. We think that some people have a specific type of anatomy that encourages friction between the two tendons. Recent anecdotal evidence suggests that hyaluronic acid injected between the two tendons reduces this friction and improves pain.
Study: A Comparison Between Prolotherapy Botox Physical Therapy And Hyaluronic Acid Injections
Here we have a September 2020 study published in the International Journal of Rehabilitation Research. In it, researchers compared the effectiveness of four treatments in the management of knee osteoarthritis.
- In total, 120 patients with knee osteoarthritis, all over the age of 50 years of age were randomly allocated to four groups.
- The test results were based on pain and functional scoring systems.
- Exercise recommendations were prescribed daily for all participants throughout the study.
- For physical therapy , participants received superficial heat, transcutaneous electrical nerve stimulation, and pulsed ultrasound.
- Botox: Researchers administered a single intra-articular injection of botulinum neurotoxin type A
- Hyaluronic acid: Researchers administered three injections of hyaluronic acid
- Prolotherapy: Researchers administered 20% dextrose to patients in the corresponding groups.
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Why You Should Get A Gel Knee Injection
1) Gel knee shots are for patients who find other treatments ineffective
This course of action is recommended for patients who dont experience relief from physical therapy or other injections. Additionally, patients with diabetes often choose gel shots since corticosteroid injections another common treatment raise blood sugar levels. If overused, cortisone can deteriorate cartilage in knees, while gel shots do not.
2) Gel knee shots last longer than other treatment options
A typical regimen of gel shots consists of three to five weekly injections. Patients can then enjoy pain relief from osteoarthritis for up to six months on average.
3) Gel knee shots are approved by the FDA
The FDA approved the first gel injections in the late 90s. There are now more than six different brands available. All of them have been deemed equally effective by independent clinical trials.
In Clinical Observations At Caring Medical The Benefit Is Seen In Injecting Bone Marrow Directly After Extracting It
The theory is that the number of stem cells is not as important as how long they live in their natural environment. In other words, when the bone marrow is directly injected, the source of stem cells is fresh and has great potential for healing. We also believe that the body knows best it can use these immature cells to regenerate all injured tissues in the joint.
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Are Cortisone Injections Good Or Bad For Arthritic Knees
TUESDAY, Dec. 21, 2021 — Cortisone injections have gotten a bad rap in recent years as a treatment for arthritis pain, because steroids are known to damage cartilage and could potentially cause the joint to further deteriorate.
Occasional cortisone shots don’t appear to cause knees to deteriorate any faster than injections of hyaluronic acid, a substance injected to lubricate joints stiffened by arthritis, the researchers said.
“Knee replacement rates were, if anything, a little bit less in the group that got the cortisone injections,” said senior researcher Dr. David Felson, a professor of medicine and epidemiology at Boston University School of Medicine.
However, Felson added that the study only looked at people who’d gotten infrequent cortisone shots to their knee, and shouldn’t be interpreted as giving the green light to regular injections for years to come.
“What we know from the study that we can trust is that a few cortisone injections won’t really cause much trouble,” Felson said. “It’s conceivable that repeated injections every three months for years won’t cause any trouble, but you can’t say that.”
“If you use it enough, it will damage the cartilage,” said Leber, who had no role in the study.
Comparing two types of shots
Unlike cortisone, hyaluronic acid gel isn’t harmful to cartilage.
Wise use is crucial
You Are Sitting In The Orthopedists Office: The Discussion Turns To Cortisone
If you have been to your orthopedist recently and are planning treatment options or surgical options you may have been given a paper handout or webpage to visit or verbal advice on what to expect if you are getting a cortisone injection into your knee.
You may have been told:
The cortisone injection is to help you now, it is not a permanent solution.
- It is to hold you over until a more effective plan can be introduced.
Physical therapy may be an option instead of the cortisone injection
- You may then be suggested to physical therapy or continued physical therapy. As we will see below, research suggests that physical therapy would work better than cortisone. But while that may be true for some, it is likely that you are at the cortisone or repeated cortisone injection stage because physical therapy has not worked for you. So you have been to physical therapy and it has not helped you. That is why you are getting the cortisone shot. In fact, you may have tried, yoga, stretching, exercise, and massage for knee pain, and these treatments just didnt help.
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