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Does Insurance Cover Knee Gel Injections

What Are Joint Fluid Replacement Injections Used To Treat

Watch A Knee Injection – Do They Hurt? Watch One Now

A joint fluid replacement injection eases the pain of osteoarthritis in a range of affected joints. These affected joints most commonly include the knee, hip and shoulder joints, but injections may be given to other parts of the body in some cases.

Osteoarthritis is caused by wear and tear on joints and results when the protective cartilage that cushions the ends of bones breaks down. This cartilage can break off into small pieces and end up in the synovial fluid, causing swelling and irritation. Discomfort and pain soon follow, but joint fluid replacement injections can often help reduce these symptoms.

Although this treatment doesnt reverse the effects of arthritis, it can alleviate pain and swelling in affected joints for several months. Not only can this greatly improve your quality of life on a day-to-day basis, but it can also help delay any need to undergo joint replacement surgery.

Joint fluid replacement injections can be used to treat osteoarthritis pain in a wide range of cases, so your doctor will advise you if this treatment is appropriate in your situation. If you require long-term management of osteoarthritis pain, your doctor may recommend that you undergo a course of injections more than once a year.

The Efficacy Of Intra

An August 2021 paper from the Department of Orthopaedic Surgery, Rush University Medical Center published in The American Journal of Sports Medicine compared the effectiveness of PRP against other knee injections in younger patients and those without severe degenerative changes. The reason? the efficacy of intra-articular injections as a nonoperative modality for treating symptomatic knee osteoarthritis-related pain while maintaining function has become a subject of increasing interest.

In this study the following treatments were compared:

  • Hyaluronic acid.
  • and plasma rich in growth factors .

Is Prp Controversial Yes Is It Effective Also Yes

When it works. Below are many citations and references showing the effectiveness of PRP.

Lets start with the most recent research on the effectiveness of PRP for knee osteoarthritis.

  • While an October 2020 study in The Journal of International Medical Research still acknowledges that the clinical efficacy of platelet-rich plasma in the treatment of osteoarthritis remains controversial, their examination of five clinical trials including 320 patients found: intra-articular injection of PRP is an effective treatment for osteoarthritis that can reduce post-operative pain, improve locomotor function, and increase patient satisfaction.
  • This is a June 2020 study from the journal Clinical Rheumatology, Here researchers suggested that Intra-articular PRP injection provided better effects than other injections for osteoarthritis patients, especially in knee osteoarthritis patients, in terms of pain reduction and function improvement at short-term follow-up. .
  • In a study published in the American medical journal Arthroscopy, medical university researchers suggested that PRP injections were more effective in the treatment of knee osteoarthritis, in terms of pain relief and self-reported function improvement at three, six, and twelve months follow-up, compared with other injection treatments. We are going to show the comparative research below.

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Are Gel Knee Injections Worth A Shot

Injections of gel-like substances may be making inroads into the established arsenal of treatments for painful, arthritic knees.

Physical therapy, nutritional supplements, anti-inflammatory painkillers, corticosteroid injections and more help some but not all of the estimated 27 million Americans with osteoarthritis, many trying to stave off joint-replacement surgery. The condition — caused by the breakdown of cartilage in the knee, usually from the wear-and-tear of normal activity over time — leaves too little cushioning between bones in the knee. Pain results, and movement becomes restricted.

So are gel injections, called viscosupplementation, worth a shot?

“My personal experience is with the right patient it does work, and it’s a reasonable choice that’s not terribly invasive,” said Dr. Michael J. Sileo, an orthopedic surgeon specializing in sports medicine in East Setauket. Sileo said he now does at least 300 to 500 gel injections in knees a year, adding that doctors who specialize only in knee treatments probably do many more.


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Dr. James Penna, an assistant professor in the orthopedics department at the Stony Brook University School of Medicine, said he’s also seen benefits from the injections.


Criteria For Initial Approval


Aetna considers viscosupplementation medically necessary for the treatment of osteoarthritis in the knee when all of the following criteria are met:

  • The diagnosis is supported by radiographic evidence of osteoarthritis of the knee or the member has at least 5 of the following signs and symptoms:

  • Bony enlargement
  • Crepitus on active motion
  • Erythrocyte sedimentation rate less than 40 mm/hr
  • Less than 30 minutes of morning stiffness
  • No palpable warmth of synovium
  • Over 50 years of age
  • Rheumatoid factor less than 1:40 titer
  • Synovial fluid signs
  • The member has knee pain which interferes with functional activities and
  • The member has experienced an inadequate response or adverse effects with non-pharmacologic treatment options and
  • The member has experienced an inadequate response or intolerance or has a contraindication to a trial of an analgesic for at least 3 months and
  • The member has experienced an inadequate response or intolerance or has a contraindication to a trial of intraarticular steroid injections for at least 3 months and
  • The member is not scheduled to undergo a total knee replacement within 6 months of starting treatment.
  • Aetna considers all other indications as experimental and investigational .

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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.

    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.

    Read Also: Inversion Table Knees

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    Before Taking This Medicine

    Gel Injections into the Knee? Did you have it done properly?

    You should not receive Gel-One if you are allergic to it, or if you have an infection in your knee or in the skin around your knee.

    Gel-One is not approved for use by anyone younger than 21 years old.

    Tell your doctor if you have ever had:

    • blood clots or circulation problems in your legs or

    • an allergy to birds, feathers, or egg products.

    It is not known whether Gel-One will harm an unborn baby. Tell your doctor if you are pregnant.

    It may not be safe to breast-feed a baby while you are using this medicine. Ask your doctor about any risks.

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    Do Medicare Advantage Plans Cover Knee Injections

    By law, Medicare Advantage plans must pay for at least as much as Medicare Parts A and B do. Generally, you can expect your plan to cover corticosteroid and hyaluronic acid injections under the above guidelines. Your plan may also provide more coverage than original Medicare. Depending on the type of insurance you have, you may need to receive the injection from a doctor, hospital or clinic that is in your plan’s network.

    Knee Pain Treatments Depend On Severity Of Pain And Damage

    Knee pain can take many forms. It may be a sharp pain, achiness, a dull burning sensation, or uncomfortable swelling or stiffness. The pain may be worse at night, and the knee may feel unstable.

    About one in four Americans lives with chronic knee pain that limits their function and mobility and interferes with their quality of life. The most common cause of knee pain? Osteoarthritis. In this progressive form of arthritis, the cartilage that cushions the ends of the bones in the knee joint wears away over time.

    Knee pain treatments depend on the severity of the pain and how advanced the damage is. Mild pain may be managed with over-the-counter, non-steroidal anti-inflammatory drugs , such as ibuprofen or naproxen , along with physical therapy or a supportive knee brace. More significant pain may require medical treatment, especially if it affects your work, exercise or everyday activities.

    Types of knee injections for pain

    If more conservative treatments arent effective, your doctor may recommend injections to relieve discomfort and restore your normal function.

    There are several types of injections to reduce inflammation in the knee joint, which can help with pain and mobility for several months or more, says Jeffrey Wilde, MD, an orthopedic surgeon with Scripps Clinic. The right choice is determined by your symptoms and your individual medical profile.


    Hyaluronic acid injections

    Platelet-rich plasma injections

    Knee replacement surgery

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    Why Dont Some Medical Groups Recommend Hyaluronic Acid Shots

    Even though some patients have gotten relief from these shots, some professional organizations, such as the American Academy of Orthopaedic Surgeons, dont recommend them due to the lack of robust scientific evidence of their effectiveness. Some studies have found these injections are not more effective than placebo injections, Dr. Miller says. However patients get a lot of relief from placebo effects of any injection, so this makes it difficult to show the independent effect of the hyaluronan. In addition, given the expense of hyaluronan injections, he says, many insurance companies are reluctant to pay for something only a little better than placebo. I pay for them from Canada because my insurance wont cover, Quina told us on FB.

    If youre interested in hyaluronic acid injections for your OA, talk to your doctor and check with your insurance company to see if they may be an option for you.

    Alternatives Not Covered By Medicare To Consider

    Injection Options for Knee Osteoarthritis

    Unfortunately, the alternative treatments that medicare covers center around pain management and not fixing the problem you have in your knee joint. Although Medicare also covers knee replacement, there are definite risks to having this surgery. And, once your joint has been replaced, you cant put it back.

    You can learn more in our article, The Case Against Knee Replacement Surgery.

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    Combined Ozone Gas And Viscosupplementation For The Treatment Of Knee Osteoarthritis

    Giombini et al compared short-term clinical outcomes between IA injection of HA, oxygen ozone , and the combination of both, in patients affected by OA of the knee. A total of 70 patients with knee OA were randomized to IA injections of HA , or O2O3 or combined 1 per week for 5 consecutive weeks. KOOS questionnaire and VAS, before treatment at the end , and at 2 months after treatment ended were used as outcome measures. Analysis showed a significant effect of the conditions in all parameters of the KOOS score and a significant effect of groups for pain, symptoms, activities of daily living and QOL. The combined group scores were higher compared to the HA and O2O3 groups, especially at follow-up. The authors concluded that the combination of O2O3 and HA treatment led to a significantly better outcome especially at 2-month follow-up compared to HA and O2O3 given separately to patients affected by OA of the knee. This was a relatively small study with a short-term follow-up . These preliminary findings need to be validated by well-designed studies.

    Hyaluronic Acid Injections Or Viscosupplementation For Knee Osteoarthritis: What To Expect When Getting Gel Injections In Knee

    Much like cortisone, it is very likely that this knee injection treatment has been explained to you already by your orthopedist. It is a conservative care plan to help you try to manage along until you can get a knee surgery scheduled or you are trying to do everything you can to avoid the knee surgery.

    Also like cortisone, you may have already had viscosupplementation and the effects and benefits have now worn off and you need to treat your knee differently. For some people, they may not even be reading this sentence because they have moved down the article to other treatments because this one is no longer an option for them.

    What are Hyaluronic acid injections or Viscosupplementation?

    The explanation that you may have been given is that hyaluronic acid injections will provide a gel-like cushion in your knee, getting between the shin and thigh bones to alleviate your bone-on-bone situation. The injections increase the volume of the protective synovial fluid in the knee.

    • The treatment is therefore referred to as Viscosupplementation because you are supplementing the viscosity or the thick, sticky, gel-like properties of the synovial fluid. Hyaluronic acid is naturally occurring in the synovial fluid of the knee.

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    Knee Patients Spending Millions On Wasted Treatments Study Finds

    Wasted treatments for knee pain have racked up millions of dollars in medical bills, researchers reported Tuesday.

    Patients who had knee replacements went through treatments such as injections that did not help, that are not recommended, and that accounted for a third of their total medical bills, the researchers found.

    Hyaluronic Acid Injections Are Classified As Medical Devices

    Gel Injections For Knee Arthritis Pain PROOF NYC Pain MD

    Interestingly, the Food and Drug Administration regards hyaluronic acid injections as class III medical devices, defined as those that “sustain or support life, are implanted, or present reasonable risk of illness or injury.” Examples of other class III devices are breast implants and pacemakers.

    However, there is some discussion of reclassifying hyaluronic acid injections as drugs, as research has shown they work primarily “through chemical action in the body.”

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