Other Injections: Hyaluronic Acid Botox And More
Some people have used other types of injections for OA of the knee.
However, experts from the American College of Rheumatology and the Arthritis Foundation dont currently recommend using these, as theres not enough evidence that they work.
Examples of other types of injections include:
- hyaluronic acid injections, also known as viscosupplementation
You may not know exactly what type of injection youre receiving or what the effect might be.
Always discuss the pros and cons of any treatment with your doctor before starting, so that you can make an informed decision.
Gel Injections For Knee Arthritis
Stiff and sore joints are a reality for most of us as we get older. Normally, our body secretes natural lubricants that reduce friction between the joint surfaces. Knee osteoarthritis increases friction in the joint causing the protective layers of cartilage on joint surfaces to slowly break down. Gel injections for knee osteoarthritis contain hyaluronic acid which can provide relief by improving joint lubrication. Treatments aimed at decreasing joint friction are also known as viscosupplementation. According to experts12, if youve tried exercising, dietary changes, and other painkilling drugs with no success, this treatment could be for you.
Viscosupplementation: Injecting lubricating substances into a joint with the goal of increasing function and decreasing pain.
Knee Injections For Arthritis: Which Is Best
Arthritis occurs when the cartilage of the joint wears away, exposing bone. This bone exposure leads to pain, swelling, and reduced function. Generally, simple treatments such as exercise, medications, and weight loss have the best effect on arthritis. However, we use knee injections for arthritis in London to help these simple treatments in complex cases. So, what are the options for knee joint injections, and how do you decide?
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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 .
Findings:
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 included only the studies that used intra-articular injection within the Prolotherapy scheme, and 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.
Injections For Knee Pain: What To Expect
How long does your knee hurt after a gel injection? It is most commonly thought to cause minor postprocedural pain improvement within a few days. It usually takes 24 hours for most patients to return to normal activities, and the pain relief from the injection should begin within that time. What should I do after injection? After receiving the injection, you should avoid strenuous activities , as well as long-term weight-bearing activities . Why does my knee hurt after getting a gel coat? In some cases, the presence of swelling or pain in the knee joint after receiving hyaluronic acid injections can be temporary. If the pain or swelling persists or worsens after you take this medication, you should consult your doctor. Do not use this medicine with quaternary ammonium salts if you have not already.
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How Do You Prepare For A Gel Shot
It is best to prepare for the treatment by discussing your symptoms and severity of your joint pain with your doctor. There should be clear communication speaking about the procedure and what to expect. Prior to the appointment day, you will have discussed with your physician any specifics you have about the injections.
Gel shots are usually recommended for patients when less invasive treatment options have not provided relief. Gel shot injections can be administered within a standard doctors office visit.
How Effective Are Hyaluronic Acid Injections For Osteoarthritis
Studies show hyaluronic acid injections may work better than painkillers for some people with OA. Other studies have shown they also may work as well as corticosteroid knee injections.
Hyaluronic acid injections seem to work better in some people than others. They may be less effective in older adults and people with severe OA.
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Simply Put Prp Methods Vary By Practitioner Research Consistently Points To Prp Ineffectiveness As Being Caused By The Way The Treatment Is Given And Poor Patient Selection
In a December 2018 paper titled: Clinical Update: Why PRP Should Be Your First Choice for Injection Therapy in Treating Osteoarthritis of the Knee, researchers wrote in the journal Current Reviews in Musculoskeletal Medicine:
Moving forward, it is imperative that future clinical research be conducted in a more standardized manner, ensuring that reproducible methodology is available and minimizing study-to-study variability. This includes PRP preparation methods PRP composition PRP injection protocols sufficient clinical follow-up and strict inclusion/exclusion criteria.
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.
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When Prp Doesnt Work It Is Usually Not The Solution Used During Treatment But How The Treatment Itself Is Given
In the Journal of Knee Surgery, doctors at the Division of Sports Medicine, Department of Orthopedics, at Rush University Medical Center in Chicago wrote:
- Traditionally, treatment options have included lifestyle modifications, pain management, and corticosteroid injections, with joint replacement reserved for those who have exhausted nonsurgical measures.
- More recently, hyaluronic acid micronized dehydrated human amniotic/chorionic membrane tissue, and platelet-rich plasma injections have started to gain traction.
- PRP has been shown to have both anti-inflammatory effects through growth factors and stimulatory effects on mesenchymal stem cells and fibroblasts .
- Multiple studies have indicated that PRP is superior to hyaluronic acid and corticosteroids in terms of improving patient-reported pain and functionality scores.
- Unfortunately, there are many variations in PRP preparation, and lack of standardization is a factor.
Is It Worth Getting Hyaluronic Acid Shots To Delay A Knee Replacement Should You Just Get The Surgery
Hyaluronic acid injections are often a last-ditch effort before knee replacement surgery. It bought me a year before replacements, Cathy Anderson Eberhardt told us on Facebook. But because the shots dont actually appear to affect the disease progression, some medical professionals think they just put off the inevitable, and only serve to tack on additional health care costs. For some people it can delay surgery or can avoid it altogether, but hyaluronans will generally not avoid eventual surgery in badly affected knees, Dr. Miller says. But, they will be helpful in patients not quite mentally ready for surgery.
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Seven Different Knee Osteoarthritis Treatments
A team of researchers from France and Belgium published a November 2021 study in the medical journal Medicine. In it, the researchers evaluated recent clinical trials on seven different non-surgical knee osteoarthritis treatments. What they were looking for is which of these treatments appeared to work the best.
The seven treatments were:
- Platelet Rich Plasma injection ,
- Corticosteroid injection,
- mesenchymal stem cells injection,
- hyaluronic acid injection,
- nonsteroidal anti-inflammatory drugs,
- nonsteroidal anti-inflammatory drugs combined with physical therapy.
What the researchers found was varying and different effects of these treatments in the research study on participants suffering from knee osteoarthritis.
- In the primary outcome , mesenchymal stem cells and PRP were significantly better than the chosen control and associated with improvement in knee status.
- Corticosteroid injection improved outcomes but did not perform better than the control.
- Ozone injection is the only intervention for which knee pain and/or function got worse at the end of the study compared with the baseline. Ozone injection showed no improvement in pain and function at 12 months.
- NSAID alone or with physical exercise was not associated with improvement in pain and function compared with the injection of hyaluronic acid.
- The combination of hyaluronic acid and dexamethasone was not associated with improvement at 3 and 6 months compared with the injection of hyaluronic acid alone.
Gel Knee Shots Can Relieve Arthritis Pain For Months
If you suffer from osteoarthritis, you know all too well that there is no known cure for the degenerative disease. Youre far too used to the wear and tear on your knees that cause painful stiffness and swelling.
However, even though doctors have not found a cure, they have discovered many treatment options that help the knee pain and joint stiffness associated with the disease. One of the most effective treatments is gel knee shots also referred to as viscosupplementation, hyaluronic acid, or rooster comb injections.
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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.
Knee Pain And Medicare Benefits
Your Medicare Part B benefits cover the cost of your knee gel injections if the administering health care provider accepts Medicare assignment and they are given in their medical facility or office or as an outpatient in a hospital. The health care provider who administers the injections is the one who purchases the medication, you dont buy it yourself.
To meet the requirement of medical necessity, certain conditions apply. You are experiencing knee pain due to osteoarthritis, regardless of whether the pain is accompanied by stiffness and swelling. Knee pain doesnt respond to other forms of therapy like weight loss or physical therapy. Knee pain doesnt respond to over-the-counter drugs like nonsteroidal anti-inflammatory medications.
Your Medicare Part B benefits cover the cost of your knee gel injections if the administering health care provider accepts Medicare assignment and they are given in their medical facility or office or as an outpatient in a hospital. The health care provider who administers the injections is the one who purchases the medication, you dont buy it yourself.
Your Medicare Part B benefits cover 80 percent of the final, approved cost of the injections and their administration. You pay the remaining 20 percent as well as your Part B deductible.
TIP: Find out which plans offer the best benefits for knee gel injections and compare them against your current coverage.
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What If Knee Injections Dont Work
Knee replacement would be the last step in the treatment process for a patient with knee arthritis. However, this should only come after the patient has tried and failed with injections, bracing, NSAIDs, use of cane/walker, and most importantly a formal physical therapy program to maximize strength, motion, and weight loss, if necessary. When these treatments dont work, or stop working, then the patients options are to live with their current symptoms, or to proceed with knee replacement.
Knee replacement is the only thing that changes what the x-ray looks like and truly gets rid of the arthritis. All of the other treatments control the symptoms. The knee replacement is an open surgery where the ends of the femur and tibia, where the damaged cartilage is, are removed and metal caps are placed on the ends of the bone with a polyethylene spacer in between. This becomes the new knee joint. Patients nowadays typically go home the same day and are walking, with assistance, the day of surgery. Physical therapy ensues and patients typically recover in about 3 months. Knee replacement is a beneficial operation in the right candidate with typically 85-90% excellent outcomes.
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.
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Can You Walk With No Cartilage In Your Knee
If left untreated, the joint, especially if it is a weight-bearing one, such as the knee, can eventually become so damaged that the person cannot walk. Apart from immobility, the pain may slowly get worse. All small articular cartilage defects can eventually progress to osteoarthritis if given enough time.
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Who Can And Cannot Have Hydrocortisone Injections
Most adults and children, including babies, can have hydrocortisone injections.
Hydrocortisone injections are not suitable for some people. Tell your doctor before starting the medicine if you:
- have ever had an allergic reaction to hydrocortisone or any other medicine
- have ever had depression or manic depression or if any of your close family has had these illnesses
- have an infection
- are trying to get pregnant, are already pregnant or you are breastfeeding
- have recently been in contact with someone with chickenpox, shingles or measles
- have recently had, or youre due to have, any vaccinations
Hydrocortisone injections can make some health problems worse so its important that your doctor monitors you.
Make sure your doctor knows if you have:
If you have diabetes and monitor your own blood sugar, you will need to do this more often. Hydrocortisone injections can affect your blood sugar control.
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The Cortisone Knee Injection Debate Goes On
A December 2020 study published in the medical journal Rheumatology gives this overview assessment of the debate surrounding the use of cortisone for a bone-on-bone knee. Here are the summary learning points:
- Existing data indicate that intra-articular corticosteroids in knee osteoarthritis provide short-term pain relief and functional improvement which may last from one to several weeks.
- At present, synovitis is the most important predictor of treatment response, and also a target for anti-inflammatory treatment for intra-articular corticosteroids.
- Our explanatory note: If you have a lot of knee swelling, cortisone may be of benefit. Please see our article treating chronic knee swelling.
Returning to the research study:
- subgroup of patients with the inflammatory phenotype with clinical features of pain, stiffness, joint swelling, and effusion are expected to be more responsive than other phenotypes who do not display clinical manifestations of inflammation.
- Our explanatory note: If you do not have chronic knee swelling, cortisone may not be an answer for you.
Returning to the research study: In some people swelling comes and goes, it is hard to suggest who cortisone would be successful for among these people.
Returning to the research study: The more suitable cortisone patient is:
The evidence then was a summary of the effects of cortisone on articular cartilage which included:
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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