How Does A Hyaluronic Acid Gel Injection Work
We are not entirely sure, but we have some ideas. One theory is that hyaluronic acid gel injection acts as a lubricant, so the joint works more smoothly. Alternatively, we think a gel injection reduces joint inflammation, pain, and swelling. However, we are sure that hyaluronic acid does not regenerate joint cartilage.
What Are Gel Knee Injections
Our bodies naturally produce a thick gel called synovial fluid that keeps our joints lubricated and properly functioning. In patients with osteoarthritis, this gel becomes watery as the cartilage in your knees breaks down and is no longer effective in protecting your joints and absorbing shock.
Doctors can temporarily restore this substance into arthritic knees via gel shots. This treatment increased the hyaluronic acid levels in your knees to that of fully functioning joints. Once this fluid is restored, patients can experience reduced creaking, grinding, and inflammation, as well as restored function in their knees and most of all, pain relief.
Although Surgery And Cortisone Are Common Randomized Trials Have Failed To Produce Evidence For Their Effectiveness Or How Much They Do Work
Moving forward on that research, a February 2020 review study with the title Medical Reversals in Family Practice: A Review, published in the journal Current Therapeutic Research, Clinical and Experimental offered these points:
- Despite inconsistent recommendations for more invasive treatments, hundreds of thousands in the United States are treated with corticosteroid injections and surgery. Although these practices are common, randomized trials have failed to produce evidence for their effectiveness.
- Because corticosteroids have an anti-inflammatory effect and because osteoarthritis is an inflammatory condition, intra-articular corticosteroids have has been used for several decades, and as many as 95% of rheumatologists use them for osteoarthritis however, in a randomized trial of patients with symptomatic knee osteoarthritis, in which 140 patients were treated with an injection of either triamcinolone or saline every 12 weeks for 2 years, there were no differences in pain between patients treated with triamcinolone or saline. Further, patients assigned to the triamcinolone treatment had a greater loss in cartilage thickness. .
- Many patients are likely better off with a less-is-more approach of low-impact physical activity and strength training exercises than cortisone or surgery.
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When Other Treatments Arent Working See If These Shots To Relieve The Painful Symptoms Of Knee Osteoarthritis May Be Right For You
Youve tried all the conservative therapies for your knee osteoarthritis, and nothing is working. You really, really dont want to go down the knee replacement surgery road yet. Whats left to try? You might want to consider hyaluronic acid injections for your knee osteoarthritis . Be warned, though: Their effectiveness is up for debate, with medical research not quite backing up how well they work.
Yet, individual patients have reported relief from their arthritis pain with the shots but not everyone. Even a CreakyJoints Facebook post soliciting feedback on patients experiences received responses ranging from they worked like a dream and amazing to they did nothing to relieve my OA knee pain and even they made my knee worse.
Read on to find out more and decide if hyaluronic acid injections are worth a shot for you.
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Avoid Knee Replacement Surgery With Gel Knee Injections
If your knees ache, youre not alone. Over 50 million Americans have arthritis, and the knees are commonly affected joints. As the disease progresses, you may face the possibility of knee replacement surgery. Fortunately, theres another step you can take first. Minimally invasive gel knee injections may delay or eliminate the need for surgery.
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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.
Hyaluronic Acid Injections Or Viscosupplementation For Knee Osteoarthritis
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 is 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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What To Expect After A Hyaluronic Acid Injection
Everyone responds to hyaluronic acid injections a little differently. You might have almost immediate relief, or it could take a few weeks for the inflammation and pain in your knees to subside. Soon you find that you can move more easily and without pain.
Most patients have pain relief for 4-6 months. You can have hyaluronic acid injections every six months or so. Many patients find that the injections provide enough relief that they can delay or even avoid knee replacement surgery.
This is especially important if you had a traumatic knee injury in the past, which can increase your risk of early-onset osteoarthritis. Joint replacements last for 10-15 years. With a current average life expectancy of over 72 years, if you can delay a knee replacement, you can avoid additional knee replacement surgeries later in life.
If you have knee pain thats interfering with your life and want to find out if hyaluronic acid injections can help, .
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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.
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What Should I Do After A Synvisc Injection
Generally, we suggest you rest the joint for at least three days after a gel shot. Exercise after injection increases the risk of a reaction, including pain and swelling.
We suggest ice and simple medication such as ibuprofen for 5-7 days if you get a reaction. Most cases settle in time. However, you should see your doctor if your knee pain or swelling doesnt resolve. Occasionally, we might need to drain the swelling and inject cortisone into the knee to settle it.
Bone Marrow Aspirate Concentrate Or Bone Marrow Concentrate Type Stem Cell Therapy
Using stem cells taken from a patients bone marrow is becoming a therapy of interest due to the potential of these mesenchymal stem cells to differentiate into other types of cells such as bone and cartilage. This is not a new revolutionary treatment, this treatment has been studied and applied for many years. It is a difficult treatment for some doctors to give. You do need experience in all aspects of the treatment to give the patient the best chance at achieving their healing goals.
Bone Marrow is the liquid spongy-type tissue found in the hallow of bones. It is primarily a fatty tissue that houses stem cells that are responsible for the formation of other cells. These mesenchymal stem cells , also called marrow stromal cells, can differentiate into a variety of cell types including osteoblasts , chondrocytes , myocytes , adipocytes , fibroblasts and others when reintroduced into the body by injection. Bone marrow also contains hematopoietic stem cells that give rise to the white and red blood cells and platelets.
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Who Should Get Hyaluronic Injections
Hyaluronic acid injections are sometimes recommended for patients with diabetes who have knee osteoarthritis because hyaluronic acid injections do not raise blood sugar the way corticosteroids do. There is no evidence, however, that suggests that hyaluronic acid injections provide significant relief for knee pain, and they are not recommended for managing knee osteoarthritis under the American College of Rheumatology and Arthritis Foundation guidelines.
What to expect:
- You may receive between one and five hyaluronic acid injections.
- If you have excess swelling and fluid buildup in your knee joint, your healthcare provider will use a needle to aspirate, or remove, the fluid before injecting the hyaluronic acid.
- You should avoid prolonged standing, walking, jogging, running, or heavy lifting for the first 48 hours after receiving a hyaluronic acid injection.
It may take up to four weeks to notice any significant improvement, and the effects can vary from two to six months. Hyaluronic acid injections may be repeated about once every six months.
Similar to corticosteroids, research examining the efficacy of hyaluronic injections has yielded mixed results, with some studies reporting significant pain relief and others reporting no effects or insignificant effects on pain.
- No major adverse events were associated with these injections
- Itcan cause a temporary increase in inflammation in the joint that was injected and has been linked to post-injection pseudgout flares.
A Brief Understanding Of The Differences Between Prp And Prgf
Studies have shown favor for the use of plasma rich in growth factors in surgical healing. The difference in the injections is that in plasma rich in growth factors red and white blood cells are removed leaving only the growth factors. The benefit of this is that in wound healing, removing the red and white blood cells will help reduce inflammation. This is why this treatment is more favored in surgical repair. As regenerative medicine outside of surgery relies on controlled inflammation, PRP is seen as a better choice in many situations where there is knee pain.
Here are the highlights of this study:
- All injection treatments except corticosteroids were found to result in a statistically significant improvement in outcomes when compared with placebo.
- PRP demonstrated a clinically meaningful difference in function-related improvement when compared with corticosteroids and placebo due to large effect sizes.
- Studies evaluating outcomes of plasma rich in growth factors reported significant improvement when compared with placebo due to large effect sizes, whereas a potential clinically significant difference was detected in the same comparison parameters in pain evaluation.
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How Is The Gel Shot Procedure Performed And What Can You Expect During Your Office Visit
During the procedure, you will be positioned in such a way that the affected joint is easily accessible. After the area around your joint is sterilized, a small amount of joint fluid will be removed before the actual injection to make room for the hyaluronic fluid.
We will use ultrasound imaging guidance to help localize and place the medication. By providing the gel shots to a region the medication has the potential to act as a shock absorber or lubricant. You may experience some pressure or slight discomfort. A small bandage will be placed over the injection site. You may receive a single treatment or weekly treatment for 3 to 5 weeks depending on the product used.
Gel Injections For Osteoarthritis In The Knee
In knees with osteoarthritis, the joint fluid can break down and not provide the cushioning your knee needs. This can contribute to the pain often experienced by patients with osteoarthritis. In addition to over the counter medication and physical therapy, often times gel injections are used as a part of the treatment of osteoarthritis to provide pain relief and improve the knees natural shock absorbing abilities.
Synvisc- One is one brand of these type of injections and has been recommended for treatment of pain in osteoarthritis of the knee in patients who have failed to respond to other treatments such as diet, exercise, and over-the-counter medications. Synvisc and other similar types of gel injections should not be used in patients with an infected knee joint, skin disease or infection around the area where the injection will be given, and should be used with caution when there is swelling of the legs due to problems with venous stasis or lymphatic drainage.
The injection contains a gel-like mixture made from a substance called hyaluronan. Hyaluronan is a natural substance found in the body and is present in very high amounts in joints. The bodys own hyaluronan acts like a lubricant and a shock absorber in the joint and is needed for the joint to work properly. The injection supplements the fluid in your knee to help lubricate and cushion the joint, and can provide up to six months of osteoarthritis knee pain relief.
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Knee Injections: An Effective Solution To Knee Pain
When you receive knee injections, you can reduce your knee pain and inflammation. One of the most common side effects is postprocedural soreness that goes away quickly. The majority of patients return to normal activity within 24 hours of the injection, and begin to experience pain relief as soon as they get home. You should avoid strenuous activities for at least 48 hours following the injection. In most cases, the pain is relieved within 4-6 months.
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.
In December 2020 Doctors at Loughborough University in the United Kingdom wrote in the journal Knee surgery, sports traumatology, arthroscopy . . . clinical applications of intra-articular injections of bone marrow-MSCs are steadily increasing , with most studies demonstrating a decrease in poor cartilage index, improvements in pain, function and Quality of Life with moderate-to-high level evidence regarding safety for therapeutic administration. However, low confidence in clinical efficacy remains due to a plethora of heterogenous methodologies utilised, resulting in challenging study comparisons. . . Overall, the benefits of intra-articular injections of BM-MSCs were deemed to outweigh the adverse effects thus, this treatment be considered as a future therapy strategy.
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Tips To Prolong The Pain
While the gel injection itself is highly effective, you can do a few things to make its effectiveness last longer. The recommendations immediately after a HA injection usually include:
Avoid Strenuous, Weight-Bearing Activities
After getting an injection, you should avoid laborious activities that include putting heavy weight on your knee. You can return to everyday activities 24 hours after getting the injection, but it is still a good idea to stay away from lifting and carrying heavy objects.
Protect Your Knee from Stress
Several daily-life activities, such as running and jogging, can result in stress on the knee. Therefore, you should avoid doing such activities for a period of time. Talk to your healthcare provider to learn which activities you should stay away from and for how long.
Dont Miss the Dose
Gel injections will work for a span of time, but you will eventually need another dose. Missing the dosage can result in pain because the hyaluronic acid in the joint has decreased.
Go over your unique dosage schedule with your doctor and try to incorporate it into your lifestyle for long-lasting relief from pain. You can always call our healthcare professionals at Oak Brook Medical Group if you have any queries regarding injection therapy.
What Is The Best Gel Injection For Knees
There is no definitive answer to this question as different people will have different opinions. Some people may find that a certain type of gel injection works better for their knees than others, so it is important to speak to a doctor or other medical professional to get advice on which injection would be best for you.
Hyaluronic acid injections have a much longer effect, lasting between 6 and 12 months. In general, a doctor injects hyaluronic acid into the knee joint as part of their treatment. Dermal reactions, bruising, and pain may be experienced at the injection site after hyaluronic acid injections. Using steroids and hyaluronic acid injections for knee osteoarthritis pain has numerous benefits. Filling a gap between injections and using steroids and hyaluronic acid to treat pain can help joints function more efficiently. Furthermore, steroids and hyaluronic acid injections may be more comfortable than corticosteroid injections and have fewer side effects.
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