Hyaluronic Gel Injections For Knee Arthritis
The results of hyaluronic acid injections for knee osteoarthritis vary with each patient. Some people experience complete relief from knee osteoarthritis symptoms, while others receive partial relief or no relief.
The injection technique for administering hyaluronic acid in the knee is called intra-articular injection. The term intra-articular injection refers to an injection given directly into the joint capsule.
The injection procedure takes a few minutes and usually does not involve any prior preparation. It is however advisable to discuss the medical history and current medications with the doctor prior to this treatment.
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, and 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.
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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Study : Two Groups Of Patients One Group Gets Prp The Other Group Gets Cortisone How Did This Comparison Work Out
In an October 2020 study also comparing PRP and corticosteroid, similar findings were recorded. PRP results were better over time and the lack of side effects should be considered if debating between one treatment or the other.
- In this study, the researchers found PRP had more significant values for improvement in comparison with corticosteroids, especially in the long-term .
- Both PRP and corticosteroid improved the functional and pain status in 30 and 180 days, but patients who had the PRP treatment showed a greater pain improvement.
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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Comparison Of Ozone Therapy Cortisone Hyaluronic Acid Injections And Dextrose Prolotherapy Injections
There is a significant amount of research surrounding the use of ozone in treating various diseases. In this section, we will limit this research to comparative research.
An October 2018 study in the Journal of Pain Research compared ozone treatments with Hyaluronic Acid Injections or Dextrose Prolotherapy injections as the control group.
Please note that this is not a comparison of Prolozone® to the other treatments, this is a comparison of ozone alone.
The researchers wrote that the existing body of evidence had well demonstrated that ozone injection was evidently effective for short-term management of mild-to-moderate knee osteoarthritis patients . But the main challenge was on longer periods of time in which different studies had declared heterogeneous results.
The researchers gathered dates from a series of randomized control trials and made these observations:
- The short-term effectiveness of intra-articular ozone is better than placebo and corticosteroids
- The short-term effectiveness of intra-articular ozone is equal to that of dextrose Prolotherapy or hyaluronic acid injections.
- However, at 36 months after injections, the therapeutic efficacy of ozone decreased to a level, slightly lower than that of dextrose Prolotherapy or hyaluronic acid injections.
- After 6 months, ozone therapy was not associated with significant improvement in range of motion and functionality
A 2015 study in the journal Anesthesiology and Pain Medicine showed that:
What Is The Follow
Your knee may feel tender for a few days after the procedure. For the first 48 hours after the injection, avoid excessive weight bearing on the leg, such as standing for long periods, jogging or heavy lifting. This is to reduce the risk of post-treatment flair.
Depending on your condition we may also suggest driving restrictions. Ice can be used to soothe your joints during the recovery process.
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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.
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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.
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In This Video Ross Hauser Md Explains How One Injection Of Prp Will Likely Not Work
A transcript summary is below the video
We will often get emails from people who had previous PRP therapy without the desired healing effects. We explain to these people that their treatment probably did not work because the single PRP injection did not resolve knee instability. The PRP may have tried to create a patch in the meniscus or cartilage to help with a bone-on-bone situation but the instability and the wear and tear grinding down the meniscus and cartilage remain.
When a person has a ligament injury or instability, the knee becomes hypermobile causing degenerative wear and tear on the meniscus and knee cartilage. In other words, the cells of the meniscus and cartilage are being crushed to death. When you inject PRP cells into the knee, without addressing the knee instability, the injected PRP cells will also be subjected to the crushing hypermobile action of the knee. The single injection PRP treatment will not work for many people. The knee instability needs to be addressed with comprehensive Prolotherapy around the joint. Prolotherapy is the companion injection of simple dextrose. This is explained in detail below.
Electrical Stimulation Combined With Corticosteroid Injection
Electrical Dry Needling is electric stimulation in needle form. A 2022 study in the Archives of Physical Medicine and Rehabilitation added electric stimulation, in needle form, to a group of knee osteoarthritis patients treatment. In this study, sixty patients with knee osteoarthritis were divided into two groups, one with electrical dry needling plus corticosteroid injection group or corticosteroid injection alone.
The corticosteroid injection group received one glucocorticoid injection during the study and the electrical dry needling plus corticosteroid injection group received a glucocorticoid injection combined with four sessions of electrical-Electrical Dry Needling.
Results: Electrical Dry Needling therapy at myofascial trigger points combined with corticosteroid injection is more effective at alleviating pain, improving dysfunction, and global change than corticosteroid injection alone for patients with knee osteoarthritis. Electrical Dry Needling may be an essential part of treatment for knee osteoarthritis rehabilitation. Over the years we have seen patients who initially did very well with some type of electric stimulation therapy. Unfortunately for many the results were not long-lasting and for this and other clinical observations we do not offer this treatment for knee pain.
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What Are The Benefits Of Gel Injections For Knee Pain
You may wonder what the benefits of knee gel injections are and why you should opt to undergo the procedure. Well, gel injections for knee pain have been around for several years and have helped thousands of people battle chronic knee pain.
There is a wide range of benefits that these injections offer, including:
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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What Happens During Viscosupplementation Treatment For Arthritis
Viscosupplementation is a relatively quick procedure that you probably can have done during a normal office visit. In general:
- Your healthcare provider will clean the area where youll have your injection.
- Usually, your healthcare provider will inject a local anesthetic into the area around your joint, so you wont feel any pain or discomfort in the area during the treatment. Your healthcare provider might use an anesthetic spray instead.
- In some cases, your healthcare provider might use imaging so that he or she can inject into exactly the right spot. Your healthcare provider might use ultrasound or another device that shows continuous X-rays.
- If you have excess fluid in your joint, your healthcare provider might remove a small amount of fluid before beginning.
- Your healthcare provider will inject the hyaluronic acid into the joint space using a needle attached to a syringe.
- A small bandage will be applied to your injection site.
Your healthcare provider can give you an even more specific idea of what to expect. Depending on the type of product you use, you may not need another shot, or you might need one to four more spread out over the next several weeks.
Cortisone Injections For Arthritis
Cortisone is the most commonly used injection. We know cortisone is a potent anti-inflammatory drug that reduces inflammation, swelling, and pain.
Overall, studies show short-term improvement in knee pain after a cortisone injection. Generally, the cortisone effect is better in milder knee arthritis cases and lasts up to 3 months. However, there is no difference between cortisone injections and placebo at six months for knee arthritis. Moreover, there are some concerns about cortisone injections for knee arthritis. For example, a recent study shows more cartilage wear after repeated cortisone injections. In addition, there is worrying evidence that having a cortisone injection could increase your risk of needing a joint replacement earlier. However, this evidence of needing a knee replacement earlier is not as strong. Therefore, we must do more studies to assess whether repeated cortisone injections harm joints.
Also, if youre planning on having a knee replacement, studies suggest you should avoid having a cortisone injeciton for up to 3 months before surgery.
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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.
Findings:
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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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Research Comparing Prp Injections Cortisone Injections And Hyaluronic Acid Injections
Doctors wrote in a January 2019 study that 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.
What Are The Differences Between Gel Shots And Corticosteroid Shots
Corticosteroid, or steroid injections, are another treatment option recommended by the American College of Rheumatology to improve joint function. These injections include corticosteroid medication and a local anesthetic. They are most effective in treating inflammatory conditions, such as rheumatoid arthritis, bursitis, gout, plantar fasciitis, psoriatic arthritis, reactive arthritis.
Corticosteroids sometimes also referred to as cortisone injections can help relieve pain and reduce inflammation in the body including ankle, elbow, hip, knee, shoulder, spine, and wrist. Like gel shots, steroids are injected directly into the joint space and can reduce pain more quickly.
Steroid injections will provide more immediate relief from pain with a faster recovery, but the relief will be more short term.
Steroid treatment is used with caution for diabetes because steroids can raise blood sugar levels. Additionally, there could be an adverse effect of this treatment for prolonged use and to those allergic to corticosteroids. In these instances, viscosupplementation may offer an alternative treatment for joint pain relief.
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