Are Hyaluronic Injections Low
A research letter in the Journal of the American Medical Association Internal Medicine, with the title: Are Hyaluronic injections low-value health care? Using Medicare Data to Understand Low-Value Health Care: The Case of Intra-articular Hyaluronic Acid Injections, backed that up withbased on high-quality evidence that hyaluronic acid injections were not associated with clinically meaningful improvement in symptoms compared with placebo injections.
This statement paper is from 2014, lets see if we can advance the research forward towards 2021.
The first stop is February 2016 and the journal Clinical Orthopaedics and Related Research. It is an editorial from Seth S. Leopold, MD. Here are the quoted learning points:
The Fact That New Research Is Pouring In On The Detrimental Effects Of Cortisone Injections Should Not Convince Anyone That Suddenly Medicine Is Being Alerted To The Risk Of Corticosteroids
The fact that new research is pouring in on the detrimental effects of cortisone injections should not convince anyone that suddenly medicine is being alerted to the risk of corticosteroids. The dangers of cortisone injections have long been known. But in eagerness by health professionals and the patients themselves to get instant relief, the dangers were accepted as part of the treatment, in other words, lets manage the pain until the patient is ready for joint replacement treatment.
In 2009, I wrote in the Journal of Prolotherapy It is my opinion that there is no doubt that the rise of osteoarthritis, as well as the number of hip and knee replacements, is a direct result of the injection of corticosteroids into these joints.
My evidence then was a summary of the effects of cortisone on articular cartilage which included:
- a decrease of protein and matrix synthesis ,
- mutation of cell shape
- growth of new cartilage inhibited,
- cartilage destruction risk and enhancement
- cartilage surface deterioration including edema, pitting, shredding, ulceration and erosions, etc, etc.
In ten years since the evidence has grown.
Can I Have Steroid Injections For Arthritis In My Neck And Head
Q) Can I have steroid injections for arthritis in my neck and head? I had them in my shoulder for rotator cuff and they were very effective.
Doreen Higgins – 2015
A) Steroid injections into the neck are used much less often than injections into the shoulder. They’re far more complicated than joint injections to the shoulder or knee, so they need to be given by specialists in hospital using x-ray guidance.
These injections are used mostly to relieve pain that radiates into the arms from the neck because of nerve irritation. They’re an option when the pain isnt settling with simple treatments such as painkillers, physiotherapy and exercises.
Some people have injections into the facet joints of the neck if the pain of arthritis in these joints isn’t improving with other treatments. Again, these need to be done in hospital, and while they may improve pain in the short term, unfortunately they don’t cure the arthritis or the pain in the long term.
This answer was provided by Dr Tom Margham in 2015, and was correct at the time of publication.
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Are Exercise And Physical Therapy Effective In Dealing With Oa Of The Knee
Mild exercise that isnt painful improves endorphins and can improve functioning over time. Physical therapy has no benefit before surgery. Swimming is the best exercise. If youre going to work out at the gym, use an elliptical machine. But keep in mind that osteoarthritis is a degenerative disease, so you are likely to need a replacement eventually.
Lose Weight To Lessen Stress On Your Knees
Extra weight puts pressure on the knees and increases stress on the joint, increasing pain and making it hard to exercise. Research compiled by the Johns Hopkins Arthritis Center confirms that carrying extra pounds raises your risk of developing knee arthritis and speeds up the destruction of cartilage that cushions the joint.
Its not easy, but losing weight can help, whether youre dealing with arthritis in one or both knees. If you are overweight or obese, consulting with a nutritionist or a bariatric specialist may be the right place to start.
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Did Prednisolone Affect My Recovery After Heart Surgery
Q) Im a rheumatoid arthritis sufferer of about 20 years, on prednisolone and methotrexate. I recently had a coronary followed by two procedures for angioplasty and a heart bypass. I believe I suffered a slower recovery because the management of my prednisolone post-operatively could have been handled better. Could you comment?
M. Childs, Kent – 2010
A) It’s difficult to comment as you dont say in what way you think the dosage of prednisolone could have been altered for the better. Some doctors believe that methotrexate should be stopped during operations and such like as it may delay healing, but clinical trials have shown no basis for this. Steroids, including prednisolone, should be increased during times of physical stress and then tapered to their former dose when the stress is over. A heart attack, or coronary, is just one example of such stress, and an operation would be another. Why do you need more steroid during times of physical stress? Normally your body produces more of these naturally occurring hormones during such periods, but if you’ve been on steroids for some time the body is less able to respond. In these cases, we artificially increase the dose of steroid to do the job the body would normally do.
This answer was provided by Dr Philip Helliwell in 2010, and was correct at the time of publication.
How And When To Have Hydrocortisone Injections
A specialist doctor will usually give you your injection. This may be at your GP surgery.
If the injection is for pain, it may contain a local anaesthetic. You might also have a local anaesthetic by spray or injection to numb the skin before the hydrocortisone injection.
You can go home after the injection, but you may need to rest the area that was treated for a few days.
You may be able to have a hydrocortisone injection into the same joint up to 4 times in a year. The number of injections you need depends on the area being treated and how strong the dose is.
If you have arthritis, this type of treatment is only used when just a few joints are affected. Usually, no more than 3 joints are injected at a time.
The dose of hydrocortisone depends on the size of the joint. It can vary between 5mg and 50mg of hydrocortisone.
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What To Expect From A Corticosteroid Injection
You can get knee corticosteroid injections right in your doctors office. Hip injections are technically more difficult and cant easily be done in the office. Doctors use fluoroscopy or ultrasound to find the right location to inject, so they dont damage nearby nerves. You will typically see a specially trained radiologist for a hip corticosteroid injection.
Before injecting the steroid, your doctor will clean the skin and inject or spray your skin with an anesthetic to prevent you from feeling the needle stick. A numbing drug like lidocaine may also be mixed into the injection.
The numbing agent typically provides some relief of the knee discomfort within a minute or two after the injection, Golnick says. They work for a few hours.
Cortisone Injections Did They Cause A Greater Risk Of Need For Knee Replacement
As we are seeing, when it comes to corticosteroid injections numerous research studies will report contradictory findings. In a March 2022 paper in the journal Arthritis & rheumatology researchers noted that recent research that intra-articular corticosteroids injections caused harmful side effects when injected into knees with osteoarthritis. As we have seen in this article, that includes the breakdown of cartilage and advancing osteoarthritis.
- This study sought to prove or disprove the risk of knee osteoarthritis progression in patients who received intra-articular corticosteroids injections over a 5-year follow-up.
Among the 564 patients in this study who suffered from knee osteoarthritis, 51 and 99 received intra-articular corticosteroids or intra-articular hyaluronan injections, respectively, and 414 did not receive any injection during follow-up.
- Compared with untreated knees, those treated with intra-articular corticosteroid injections had a similar risk of incident needing total knee replacement or osteoarthritis worsening. Intra-articular hyaluronan injections injections had no effect on the risk of total knee replacement or or osteoarthritis worsening.
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How Long Does A Cortisone Injection Last
At times the relief from a cortisone injection begins almost immediately after the procedure, but it can take a few days for relief. A cortisone injection administered for certain conditions may be curative , but with some conditions the symptoms of the condition recur after weeks or months. In this situation, another cortisone injection can be given, but risks of side effects increase with more frequent or regular injections.
But Cortisone Is Being Recommended And You Are Being Pain Managed Until Such Time As You Can Get A Joint Replacement Are There Options
At Caring Medical, our option is to fix the joint or spine by rebuilding and repairing damaged tissue with regenerative injections. We can accomplish this with Prolotherapy and Platelet Rich Plasma Injections used together.
- Comprehensive Prolotherapy is an injection technique that uses a simple sugar, dextrose, and in some cases, it is combined with Platelet Rich Plasma Therapy to address damage and micro-tearing of the ligaments or soft tissue in the knee. A series of injections are placed at the tender and weakened areas of the affected structures of the knee. These injections contain a proliferant to stimulate the body to repair and heal by inducing a mild inflammatory reaction.
The localized inflammation causes healing cells to arrive at the injured area and lay down new tissue, creating stronger ligaments and rebuilding soft tissue. As the ligaments tighten and the soft tissues heal, the knee structures function normally rather than subluxing and moving out of place. When the knee functions normally, the pain and swelling go away.
- Natures way is for chondrocytes to repair the damage. Our therapies can assist in this process and accelerate healing.
- During this healing, the body produces its own specialized inflammatory process that acts as a protective barrier to protect the new cartilage that is being built.
- Once the repair is complete, our body shuts down the inflammation. The inflammation is no longer needed.
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You Can Delay Knee Replacement Realistically For About 11 Months With Hyaluronic Acid Injections
In September 2020, a study in the journal American Health and Drug Benefits, assessed the value of intra-articular hyaluronic acid injections monetarily. This is a way to determine the effectiveness of the treatment. This is what the study said:
Although limiting hyaluronic acid use may reduce knee osteoarthritis-related costs, in this study hyaluronic acid injection only comprised a small fraction of the overall costs related to knee osteoarthritis. Among patients who had a knee replacement, those who received treatment with hyaluronic acid had surgery delayed by an average of 10.7 months.
Why Is Knee Injection Done
Knee injection is performed to treat the pain arising from various diseases of the knee joint. The type of medication injected and the frequency depends on the condition being treated. Based on the diagnosis and extent of the disease, the doctor would recommend a treatment plan.
Indications for the various agents used for knee injections are as mentioned below.
- Botox inhibits the sensory neurons causing pain. Hence, joint pain and stiffness significantly improve.
Platelet-rich plasma injections
- PRP is obtained from the patients own blood. It contains growth factors that stimulate collagen formation and lubricate the joint. PRP can improve joint function and reduce pain.
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Research Comparing Prp Injections Cortisone Injections And Hyaluronic Acid Injections
Doctors wrote in a January 2019 study that while PRP injections, cortisone injections, and hyaluronic acid injections are considered equally effective at relieving patient symptoms at three months, at 6, 9, and 12 months the PRP injections delivered significantly better results.
A July 2020 study published in the Journal of Pain Research also suggested that PRP injections provided better results for patients than hyaluronic acid injections. The studys conclusions were: Besides significantly higher satisfaction belonging to the group, there was a statistically significant improvement in pain and function scores at 12 months compared to hyaluronic acid injections
In research published in the Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, PRP was shown to provide significant healing of the meniscus as well as out out-perform hyaluronic acid in patients with knee joint cartilage degeneration. Similar results were documented in the journal Archives of physical medicine and rehabilitation.
An August 2021 paper in the Orthopaedic Journal of Sports Medicine suggests however that corticosteroid and hyaluronic acid injections are favored for different knee problems, while PRP currently has insufficient evidence to make a conclusive recommendation for or against its use.
The Debate Over Hyaluronic Acid Injections Knee Injections One Study Suggests That Hyaluronic Acid Is A Waste Of Time Money And Resources Another Study Says It Works Okay
We do see many patients who have tried hyaluronic acid injections. For some, they did have a degree of success and the injections provided short-term pain relief. Many of these people are now in our office because the short-term has not transpired to the long-term and now they are on the path to knee replacement.
The idea behind hyaluronic acid injections is to protect the knee by reintroducing lost or diminished hyaluronic acid in the knees synovial fluid or providing a cushion. The synovial fluid is a thick gel-like liquid that helps cushion the knee and acts to absorb the daily impact of walking and running and stair climbing our knees are subjected to.
The treatment of Hyaluronic Acid Injections is also called Viscosupplementation supplementing the viscosity or the thick, sticky, gel-like properties of the synovial fluid. People will also recognize these injection treatments as Viscosupplementation rooster comb injections, rooster shots, chicken shots, as well as by trade names Euflexxa ®, Supartz ® Supartz FX ®, Synvisc-One ®, Synvisc ®, Hyalgan ®, Orthovisc ®, et al. All these products offer subtle differences in their treatment goals including the number of injections however, none of them offer a permanent solution. This is what the American Academy of Orthopaedic Surgeonsposted on their website:
We have two studies here: The first says Hyaluronic Acid Injections are okay. The second says Hyaluronic Acid Injections are a waste.
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This Is A Hip Procedure On A Runner Who Has Hip Instability And A Lot Of Clicking And Popping In The Front Of The Hip
In this video Prolotherapy treatments are demonstrated by Ross Hauser, MD:
- This is a hip procedure on a runner who has hip instability and a lot of clicking and popping in the front of the hip.
- This patient has a suspected labral tear and ligament injury.
- The injections are treating the anterior part of the hip which includes the hip labrum and the Greater Trochanter area, the interior portion, the gluteus minimus is treated.
- The Greater Trochanter area is where various attachments of the ligaments and muscle tendons converge, including the gluteus medius.
- From the front of the hip , we can treat the pubofemoral ligament and the iliofemoral ligaments.
- From the posterior approach, Im going to inject some proliferant within the hip joint itself, and then, of course, were going to do all the attachments in the posterior part of the hip and that will include the ischiofemoral ligament, the iliofemoral ligaments. We can also treat the attachments of the smaller muscles too including the Obturator, the Piriformis attachments onto the Greater Trochanter
- Hip problems are ubiquitous, the hip ligament injury or hip instability is a cause of degenerative hip disease and its the reason why people have to get to get hip replacements.
Comparison Research: Hyaluronic Acid And Prolotherapy Injections
In November 2021 doctors publishing in the American Journal of Physical Medicine & Rehabilitation evaluated the effectiveness of Prolotherapy for pain reduction and improvement of function in individuals with knee osteoarthritis in comparison with hyaluronic acid by meta-analysis . Six studies were included .
In favor of prolotherapy
- No statistically significant differences were found between prolotherapy and hyaluronic acid in pain control in the short term, however, the sub-analysis were included only the studies that used intra-articular injection within the prolotherapy scheme, an effect was found in favor of the prolotherapy groups.
- An effect was found in favor of the prolotherapy group in the improvement in function.
- No major adverse reactions or side effects were reported in any of the studies.
- Prolotherapy appears to be an effective intervention to decrease pain and improve function in knee osteoarthritis, with efficacy similar to intra-articular injections with hyaluronic acid in the short-term follow-up.
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Are There Any Additional Risks With Injections During Covid
A steroid is considered to be an immuno-suppressant drug meaning that it can reduce your immunity to fight infection and makes you more susceptible to catch any infection for a few days after. Steroid injections seem to have smaller effect on immunity than tablet forms. It is advisable to follow appropriate precautions as per government guidelines for couple of weeks after injection. No such risks are associated with HA or PRP injections.
Can I Keep Taking Steroids
Q) I am 84 and have osteoarthritis of the hip. In 2009 I was diagnosed with polymyalgia rheumatica and put on 30 mg of steroids which rapidly sorted the pain of both the hip and the PMR. By 2011 the prednisolone was tapered to 5mg every other day. I insist on continuing with the 5 mg of prednisolone every other day because together with 2 g of paracetamol daily it alleviates the hip pain. Am I right in believing that this continuing dose contributes to pain relief and is unlikely to cause harm? I have a DEXA scan every six months which has now shown osteoporosis. It is patently absurd for an 85-year-old man to risk hip replacement so he can run instead of hobble opiates are very unpleasant, and NSAIDs produce ulcers.
G.R. K, Herts – 2013
This answer was provided by Dr Philip Helliwell in 2013, and was correct at the time of publication.
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