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.
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.
Although Surgery And Cortisone Are Common Randomized Trials Have Failed To Produce Evidence For The Effectiveness Of Surgery Or Cortisone Injection 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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How Effective Are Hyaluronic Acid Injections In Remedying Chronic Knee Pain
Maybe your knee pain is worse when you wake up in the morning and are just starting to move around for the day. Or perhaps, by the end of the day, your knees are screaming for relief. Whatever your experience with knee pain, we know you want effective relief now.
Our anesthesiologist and pain management expert Syed Nasir, MD, here at Skilled Pain Care Clinic, PA, in Houston and Katy, Texas, offers an expert diagnosis of the many conditions and injuries that can cause knee pain. He creates personalized treatment plans to reduce your pain quickly and heal the underlying condition for long-term relief.
One of the many treatments available are hyaluronic acid injections, but are they useful for all types of knee pain?
Do Hyaluronate Knee Injections Work For Everyone
Osteoarthritis of the knee can lead to chronic pain, frustrating stiffness, and diminished ability to do the things you love. It can even affect your ability to get around normally. While many different treatments for knee osteoarthritis and other knee pain exist including oral pain medications, steroid injections, physical therapy, and dietary changes hyaluronate injections are a valuable option.
These injections, also called viscosupplements, involve putting a natural-like gel into your knee joint. This gel is much like the naturally occurring hyaluronic acid found in the synovial fluid that normally surrounds your joints. Hyaluronan in the injections acts like a shock absorber and lubricant.
This lubricant can help make painful joints move more smoothly, reducing discomfort and helping improve function. The injections can be a boon for some people, but they simply dont work for everyone. Read on to learn if its a treatment you should talk to us about trying.
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What Is Viscosupplementation Treatment For Arthritis
During viscosupplementation treatment for arthritis, your healthcare provider injects hyaluronic acid into your joint. This thick fluid may help reduce pain and swelling in your arthritic joint .
The bones that make up your joints usually have a cap of cartilage on their ends. This cartilage helps make sure that your bones move smoothly against each other. This cartilage has a fluid coating that contains hyaluronic acid. This works like a lubricant and shock absorber in your joint.
In osteoarthritis , this cartilage cap breaks down. When this happens, the bones of your joint scrape together abnormally. People with osteoarthritis generally have less hyaluronic acid in their joints than they should. All of this causes symptoms like pain, stiffness, and swelling. The idea behind viscosupplementation is that replacing this hyaluronic acid may help reduce symptoms.
Your healthcare provider may first inject a numbing medicine into the space around your knee joint and possibly drain any fluid that is causing the joint to swell. Then, your healthcare provider will inject hyaluronic acid into the space inside your joint. You shouldnt expect this to reduce your pain right away. After the full course of treatment, though, you may notice some pain relief.
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.
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What Are The Possible Side Effects Of Knee Therapy
While the benefits can be significant, its important to understand the risks of any treatment you pursue. Gel knee injections may cause a few possible side effects, but they are quite minor compared to ongoing prescription drug use or corticosteroid injections. These include:
- Bruising and swelling at the injection site
- Skin irritation, rash, or itching around the knee
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Are Gel Shots In The Knee Painful
There is no one definitive answer to this question as everyone experiences pain differently. However, in general, gel shots in the knee are not considered to be too painful. Many people report feeling a brief, sharp pain when the needle first enters the skin, followed by a duller ache as the gel is injected. The entire process usually takes less than a minute and the pain should subside pretty quickly thereafter. Of course, if you have a particularly low pain threshold, you may find the whole experience to be quite uncomfortable. In any case, it is always best to consult with your doctor beforehand to see if gel shots are right for you.
Injections into the knee are a common treatment for arthritis pain. It takes several injections into the knee joint to work. Temporary pain, swelling, and/or fluid accumulation in the injected knee are the most common side effects. It is recommended that you refrain from strenuous activities with your knee for at least 48 hours after receiving injections. Walking is permitted in some cases as part of routine activities.
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 Is Durolane Given
Durolane is injected directly into your knee joint. A healthcare provider will give you this injection.
A single injection of Durolane provides pain reduction in patients with knee osteoarthritis for up to 26 weeks.
To prevent pain and swelling, your doctor may recommend resting your knee or applying ice for a short time after your injection.
Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.
Tell your doctor if your symptoms do not improve, or if they get worse.
When Should I Consider Synvisc
Synvisc-One is for people with knee osteoarthritis who have not received enough pain relief from diet, exercise and over-the-counter pain medication. If youve tried these options and are still feeling knee pain, tell your doctor and ask if Synvisc-One could help.
Still wondering if Synvisc-One could be right for you? Watch this video to find out more.
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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.
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:
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Effects Of Gel Injection On Knee Pain And Inflammation
Hyaluronic acid injections are an effective and safe solution to suppress chronic knee pain. When applied in the right dosage and concentration, these injections can reduce swelling, improve mobility, ease discomfort, and relieve pain in the knee.
In most cases, one shot of this gel injection can provide up to six months of osteoarthritis knee pain relief. However, the effectiveness of each course of gel injection depends on the cause of knee pain. Our team of qualified healthcare professionals always recommends the best option based on each patients distinct condition.
In addition to having the potential to reduce knee osteoarthritis symptoms, the gel injection treatment also provides the following properties:
Better Lubrication of Joints
One of the leading causes of chronic knee pain is reduced lubrication in the joint. By getting gel injections, you can revive the joints lubrication, while it also helps improve shock absorption capability.
The hyaluronic acid restores the natural movement of the joint by reducing friction and stiffness. Getting HA injections as prescribed by your doctor can help you with long-lasting pain relief.
Another property of HA injections for knee pain is reduced inflammation. People with osteoarthritis in the knee may experience symptoms like inflammation and swelling around the joint.
These injections reduce the friction and, therefore, help suppress the inflammation or swelling up to a remarkable extent.
How Often Are Gel Shots Administered
It mainly depends on the condition of your knee and other things, such as the severity of the pain. An expert will administer the HA injections multiple times over a period of several weeks as prescribed in your treatment plan.
The gel injections can provide instant relief from pain, help to restore the cartilage layer, and maintain its healthy function. Hence, the joints become more flexible after the treatment and help you gain long-term comfort as well as mobility.
Talk to our gel injection experts at the Oak Brook Medical Group and learn more about this treatment. We will evaluate the anatomy of your knee to tell you more about how many shots you need while making a treatment plan.
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