Am I A Good Candidate
Like any treatment for knee arthritis, some individuals respond better than others. Approximately 50% of patients have a noticeable improvement in their knee function and pain after receiving gel injections3. Much research has been done to understand the characteristics of people who consistently respond well to gel injections for knee arthritis4.
If you are considering getting gel injections for knee arthritis, take a look at the candidacy checklist. This tool is based on a 2011 study4 reviewing past scientific research on the effect of hyaluronic injections on those with knee osteoarthritis. The better candidate you are the more likely you are to have a positive experience. If you want to learn more or feel like this treatment could be for you, discuss your specific situation with your doctor.
Likely Factors For Success
The people who do seem to respond best to hyaluronate knee injections are of normal weight and have only the beginning stages of osteoarthritis. The injections are most effective in people with just mild to moderate arthritis. If youre highly overweight or obese and have advanced osteoarthritis, the injections are less effective.
Hyaluronate injections also seem more effective on people younger than 65. If youve never had treatment with hyaluronate or steroid shots, youre also a better candidate.
High Levels Of Exposure
Cortisoneespecially when used on a long-term basismay break down tissues, such as tendons, ligaments, and cartilage in the knee joint.Cartilage acts as a shock absorber, reducing the friction between bones as they move.
For this reason, it is not recommended to get repeated cortisone injections in the same joint over a short period of time, as it may cause more harm than good. If more than one injection is given in the same joint, the injections should be scheduled at appropriate intervals. Patients should not receive more than three to four cortisone injections per year.
Anytime a needle is injected into the skin, there is a chance of infection. An antiseptic will be applied to the skin prior to injection to reduce the risk of infection.
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The Different Ways To Treat Osteoarthritis
Osteoarthritis causes pain, stiffness, and loss of joint function. If the disease progresses, the joint may become completely useless. There are several options to relieve symptoms and improve joint function in osteoarthritis, but there is no single treatment that can completely cure it. There are several treatment options available to you, including physical therapy, medication, and surgery. A variety of therapies can be used to treat osteoarthritis, which is a common condition.
What Is The New Injection For Knee Pain
In addition, the FDA approved a single-injection hyaluronic acid gel and an extended-release formulation of the synthetic corticosteroid triamcinolone acetonide for the treatment of osteoporotic arthritis
Steroid Injections: A Long-lasting Treatment For Knee Pain
If you suffer from knee pain and want to avoid it for a long period of time, steroid injections may be the answer. Hyaluronic acid injections can provide temporary pain relief, but they typically fade over time. A steroid injection, which contains steroids, will last longer and provide greater pain relief.
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Direct Injection Of Fat Stem Cells
In reviewing the cumulative research of both animal and human studies, doctors at the Rizzoli Orthopaedic Institute in Italy, published in the journal Stem Cell International, found the injection of adipose-derived mesenchymal stem cells was first, safe and effective, and that secondly, several aspects favor the use of freshly harvested adipose-derived mesenchymal stem cell instead of expanded or cultured adipose-derived mesenchymal stem cell.
Lets explore this research a little further. The researchers looked at 11 clinical studies. In these studies, the application of fat stem cells into the knee was performed in many different ways including during arthroscopic knee procedures. This is what they found:
- Ten out of the 11 clinical studies reported the use of non-expanded autologous adipose-derived stem cells.
- Adipose tissue was obtained by liposuction from the abdominal area or buttocks in all cases, except for two studies where infrapatellar fad pad tissue was harvested during knee arthroscopy.
- However, in the studies where infrapatellar fad pad tissue was used, those studies authors concluded that more adipose-derived stem cells can be obtained from the buttocks than from infrapatellar fad pad, with the same differentiation potential in both sources.
The published results of this study were:
Amniotic Cord Blood And Placenta Tissue
There is a great amount of misinformation surrounding amniotic stem cell therapy, and umbilical cord blood stem cell therapy.We have never offered these treatments.
The primary reason we do not offer these products is that we did not find them to be more effective or economically viable to the patient than the utilization of the patients own stem cells and because we find simple dextrose Prolotherapy and Platelet Rich Plasma to be effective treatments which, in our observations, yield similar if not better results.
Amniotic stem cells marketed in many chiropractic offices are, in reality, micronized amniotic fluid. The micronization process takes amniotic fluid, freeze-dries it, and then processes it. The process kills the stem cells. NO live stem cells are present. However, growth factor remnants remain.
Many people attend webinars and seminars on the benefits of amniotic/placenta, umbilical cord stem cell therapy. These seminars are often conducted by a chiropractor whose presentation includes a segment on how the attendees of the seminar have joint pain because their own stem cells are too few, too weak, too feeble, and too old to repair the damage.
The great irony of this argument is if you have been told that your own stem cells are too few, too weak, too feeble, and too old, how does the amniotic tissue then work if it has no new stem cells in it?
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Why Would An Arthritis Patient Get Hyaluronic Acid Injections Vs Other Treatments
Typically, you would try other conservative treatments first, like weight loss, exercise, NSAID medications, and steroid injections. If those dont help, hyaluronic injections may be an option.
Some patients might have other conditions for which for first-line treatments would be contraindicated. Some doctors might use hyaluronic acid injections along with steroid injections as well. I had the injection every week for three weeks along with cortisone injections, Sharon Ruoto told us on Facebook. I did this every six months for years.
Although hyaluronic acid is also available as a pill, the shots are usually preferred. Advantages are targeted relief to the joint with no systemic side effects from pills, and the convenience of not taking pills by mouth, Dr. Miller says. Brand names of the hyaluronic acid shot include Euflexxa, Supartz, and Synvisc-One.
Why You Should Get A Gel Knee Injection
1) Gel knee shots are for patients who find other treatments ineffective
This course of action is recommended for patients who dont experience relief from physical therapy or other injections. Additionally, patients with diabetes often choose gel shots since corticosteroid injections another common treatment raise blood sugar levels. If overused, cortisone can deteriorate cartilage in knees, while gel shots do not.
2) Gel knee shots last longer than other treatment options
A typical regimen of gel shots consists of three to five weekly injections. Patients can then enjoy pain relief from osteoarthritis for up to six months on average.
3) Gel knee shots are approved by the FDA
The FDA approved the first gel injections in the late 90s. There are now more than six different brands available. All of them have been deemed equally effective by independent clinical trials.
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Reverse Injection: Fluid Aspiration
Fluid aspiration from a joint, called arthrocentesis, is the process of inserting a needle into a joint to remove excess fluid. The knee is the most frequently aspirated joint.
Joint inflammation and swelling that occur due to osteoarthritis can produce excess synovial fluid within the knee, restricting movement and causing increased pain. Removing the fluid by aspirating the joint with a needle can help reduce pain and improve swelling.
- Your healthcare provider may use a local numbing agent, such as lidocaine, either topically around the knee or by injecting it within the knee joint.
- A needle is inserted into the knee joint at either side of the patella, and a syringe is used to pull fluid out of the knee.
- Fluid aspiration may be performed by itself or prior to receiving another type of injection, and generally takes 30 minutes or less to complete.
- The numbing agent will typically wear off after two to four hours. It is common to have some pain or soreness for one to two days after the procedure.
Pain relief from fluid aspiration can last for six months or more.
While arthrocentesis is often performed for diagnosis and prior to joint injection, it is not typically used on its own for therapeutic purposes, as it does not fix the underlying issue that caused the joint effusion .
Who Is A Candidate
Gel injections are usually given after other more-conservative measures have proven ineffective. Most physicians will recommend that you first complete a course of physical therapy to increase the strength in the muscles that surround your knee. The physician may prescribe an anti-inflammatory medication or recommend an over-the-counter anti-inflammatory as part of a less-invasive approach. If exercise and medication do not control your symptoms, your physician may then recommend that you try gel injections.
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The Debate Over Hyaluronic Acid Injections And 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.
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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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.
Repeated Courses Can Be More Effective
Multiple shots of these gel injections can provide lasting relief from knee pain, and the results may be better compared to a single injection.
Depending on your case, you should talk to your doctor about the prescription for gel injections. Sometimes, a single injection is enough for lasting relief if the cause of knee pain is in its initial stages.
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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.
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What Happens During A Hyaluronic Acid Injection
Here at Skilled Pain Clinic, Dr. Nasir begins with a thorough consultation and exam to identify the cause of your knee pain. He needs to understand the cause of your pain in order to prescribe the most effective treatment. If you have osteoarthritis, and Dr. Nasir thinks hyaluronic acid injections will relieve your pain, he can provide hyaluronic acid injections during a brief visit.
When you have the injection, Dr. Nasir cleans the skin on your knee and may inject a local anesthetic. If you have severe swelling, he may perform a joint aspiration to extract some of the excess fluid. Then, using an X-ray to guide the needle, he injects the hyaluronic acid into your knee.
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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.
Knee Injections Side Effects
Side effects for both types of injections are relatively minimal. Patients can expect some initial soreness and pain at the injection site which should subside in 24-48 hrs. Patients with diabetes may note a temporary rise in blood sugar levels for 48-72 hrs after cortisone injections. With any injection, there is a small risk of infection. With gel injections, there is a reported 5% risk of a pseudo-sepsis reaction where they can develop a red, hot swollen knee which mimics infection. This typically improves with ice and NSAIDs after infection is ruled out. Long term use of cortisone can be damaging on healthy cartilage, but the majority of patients who we recommend cortisone injections for are those who already have damaged cartilage, aka, arthritis.
The good news is that patients can almost always expect some sort of relief from at least one of these types of injections. The real question will be which one works best for them and how long do the effects last. Cortisone injections tend to work quickly, and provide relief, but this can be as short as a few weeks or as long as several months. The gel injections tend to be effective for about 50% of patients, but for those that it works well for those patients tend to see improvement in VAS scores for at least 4-6 months.
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How Do Prolotherapy Injections Work For Knee Pain
In this section, we will discuss Prolotherapy knee osteoarthritis injections. Prolotherapy is a remarkable treatment in its simplicity. The treatment can help many patients avoid joint replacement. But it is not a miracle cure. The research and evidence for how Prolotherapy may help you are presented here and intermingled with our own 28+ years of empirical observation of patient benefit.
A June 2022 paper in the journal Clinical Rehabilitation describes the controversies and benefits of Prolotherapy injections. In examining previously published data, the researchers found: Compared with placebo injection and noninvasive control therapy, dextrose Prolotherapy had favorable effects on pain, global function, and quality of life during the overall follow-up. The researchers then concluded: Dextrose Prolotherapy may have dose-dependent and time-dependent effects on pain reduction and function recovery, respectively, in patients with knee osteoarthritis. Due to remarkable heterogeneity and the risk of biases across the included trials, the study results should be cautiously interpreted.