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How Long Do Gel Knee Injections Last

How Many Cortisone Shots Can You Have

Treatments for Knee Pain: Injections or Surgery? with Dr. Jeffrey Wilde | San Diego Health

There is no medical limit on the number of injections a person can receive. However, there are concerns about repeated cortisone injections in specific areas of the body. Also, individual response to a cortisone shot varies. Some patients do not experience pain relief with cortisone treatments. If the first injection doesnt provide pain relief, your doctor may try a second injection four to six weeks later. If theres no improvement after the second injection, a third injection is not recommended.

Another Comparison Of Ozone Prp And Hyaluronic Acid

A February 2021 study compared the short and long-term efficacy of the intraarticular injections of hyaluronic acid, platelet-rich plasma , plasma rich in growth factors , and ozone in patients with knee osteoarthritis.

  • 238 patients with mild to moderate knee osteoarthritis were randomized into 4 groups:
  • hyaluronic acid ,
  • PRP ,
  • PRGF , and
  • Ozone .

Results: In 2 months of follow-up, significant improvement of pain, stiffness, and function were seen in all groups compared to the baseline, but the ozone group had the best results. In 6 month follow up hyaluronic acid, PRP, and PRGF groups demonstrated better therapeutic effects in all scores in comparison with ozone. At the end of the 12th month, only PRGF and PRP groups had better results versus hyaluronic acid and ozone groups in all scores. Despite the fact that ozone showed better early results, its effects begin to wear off earlier than other products and ultimately disappear in 12 months.

Side Effects Of Knee Osteoarthritis Injections

Potential side effects of these knee osteoarthritis injections include joint swelling and pain. They can’t be used by people with skin or joint infections. In addition, most varieties are made from processed chicken or rooster combs and should not be used in people with egg or poultry allergies. Euflexxa, however, is safe to use in people with egg allergies.

Occasionally, a severe reaction with swelling, redness, and pain, called a pseudoseptic reaction, can occur with some forms of these viscosupplementation materials.

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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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Bone Marrow Aspirate Concentrate Or Bone Marrow Concentrate Type Stem Cell Therapy

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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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What Does The Procedure Involve

You can usually receive a knee injection in your doctors office. The procedure only takes a few minutes.

Youll be seated during the procedure, and your doctor will position your knee. They may use ultrasound to help guide the needle to the best location.

Your doctor will:

  • clean the skin on your knee and treat it with a local anesthetic
  • insert the needle into your joint, which might cause some discomfort
  • inject the medication into your joint

Though you may feel some discomfort, the procedure is rarely painful if your doctor has experience administering this type of injection.

In some cases, your healthcare provider may remove a small amount of joint fluid to reduce pressure.

Theyll insert a needle attached to a syringe into the knee joint. Then, theyll draw out the fluid into the syringe and remove the needle.

After removing the fluid, the doctor can use the same puncture site to inject the medication into the joint.

Finally, theyll place a small dressing over the injection site.

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?

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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, 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.

Growth And Healing Factors In Prp This Is What Makes Prp Work

Do gel injections eliminate knee pain?

A paper in the journal Clinical Cases in Mineral and Bone Metabolism describes the growth, healing, and repair factors found in platelet-rich plasma. These are the healing factors and what they do:

  • VEGF is the major regulator of vasculogenesis and angiogenesis and plays an important role in tissue regeneration. It does so by creating new highways of blood vessels for the healing factors to get to the site of the injury.
  • Transforming Growth Factor including TGF-b1 stimulates chondrocyte and decreases the catabolic activity . There is also research to suggest that TGF-bi stimulates stem cell activity in the injured area.
  • So the concept is here. These healing growth factors in your blood are taken and spun, to separate out a platelet-rich plasma solution filled with these healing and growth factors, and then the solution is injected into your knee.

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    Research Comparing Prp Injections Cortisone Injections And Hyaluronic Acid Injections

    Doctors wrote in a January 2019 study that while 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.

    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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    Platelet Rich Plasma Injections Comparison

    Platelet Rich Plasma Therapy is a blood injection taken from the patients own blood and reduced down to plasma that is heavy with platelets. Blood plasma platelets hold and encourage many healing growth factors that stimulate healing in degenerated tissues. PRP has also been shown to be superior to hyaluronic acid injections in many studies documented below.

    In our article Platelet Rich Plasma for Knee Osteoarthritis: When it works, when it does not, we point to more research on when the treatment can be successful and when the treatment may not help you.

    Research comparing PRP injections, cortisone injections, and hyaluronic acid injections

    Doctors wrote in a January 2019 study that while 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.

    Here is a summary of further research findings:

    Combining Prp And Hyaluronic Acid

    Can Hyaluronic Joint Injections Relieve Pain From Joint Inflammation?

    A team of Italian researchers examined the role of a combined hyaluronic acid and PRP treatment in a March 2021 published study.

    In this study, clinical outcomes of patients suffering from mild or moderate knee osteoarthritis were treated with Leukocyte and platelet-rich plasma or PRP + hyaluronic acid intra-articular injections. Outcomes were observed 3 months and 1 year after the injective treatment.

    A significant improvement of pain score was present in both groups, the Leukocyte PRP group, and the PRP + hyaluronic acid. Pain reduction was effective after 3 months and improved after 1 year. The group treated with PRP + hyaluronic acid showed a significant improvement in knee mobility and function scores. In both groups, however, the improvement in Knee injury and Osteoarthritis Outcome Score , a self-reported measure of functional ability and knee-related quality of life, did not reach significance.

    What does this mean? The researchers concluded: In our point of view, we encourage the use of PRP injections as a simple, safe, and minimally invasive treatment approach. Our comparison of PRP + hyaluronic acid and Leukocyte-PRP suggests that PRP + hyaluronic acid could possibly determine better functional and mobility outcomes. However, our work could not be sufficient to definitively suggest a therapeutic choice: Further evidence is needed.

    What is Leukocyte- and platelet-rich plasma treatment? What is its connection to hyaluronic acid?

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    In The Past Your Doctor May Have Recommended Against The Use Of Cortisone Because It Was Clear To Him Or Her That There Was A Knee Surgery In Your Future

    In the past, your doctor may have recommended against the use of cortisone because it was clear to him or her that there was a knee surgery in your future. The concern is if you get cortisone injections into your knee prior to surgery, you will have a greater risk of complications after the surgery. There is a lot of debate around this subject. Some doctors say avoid the cortisone, other doctors are saying it is okay to get one shot to hold you over until you can get surgery or maybe the cortisone will reduce your inflammation enough after the first shot that you will have some degree of pain relief and comfort for a few months, a year, maybe longer.

    We are going to start with cortisone because cortisone was the injection of choice. Much has changed.

    In a January 2021 paper from doctors at Northwestern University McGaw Medical Center, Rutgers School of Medicine, and Boston College, a current guideline was given for the use of cortisone: The paper appeared in the journal Pain Physician and included the following observations.

    How A Cortisone Shot Works

    A cortisone injection is designed to reduce inflammation in a specific area for 6 weeks to 6 months. The length of pain relief appears to depend on the location and the type of injury. While it is not a pain reliever, that is generally the effect of of reducing inflammation.

    Cortisone is naturally produced in the body by the adrenal gland and released when the body is under stress. A cortisone shot is synthetically produced, but similar to the bodys own production.

    How to get one?Usually a doctor can do this right in the office, no need for additional appointments. They may have an ultrasound machine to guide the specific location, but it seems most doctors have done it enough they just find the spot and quickly give you the shot. There is a little discomfort with the shot, but its minimal.

    Immediate effects?Initial pain relief is from the anesthetic that is usually mixed in to the steroid. After it wears off in 8-14 hours pain may return, which I hope makes it clear that cortisone shots are steroids, just not the kind that make you hulk up in the gym.

    3-4 Days after shot?The steroid will begin working and the anti-inflammtory effects should begin.

    What should you do after a cortisone shot?Because of the immediate reduced pain thanks to the anesthetic, what most of us want to do is everything the injury has been stopping us from doing!! Quickest way to make everything worse.

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    Corticosteroid Knee Injections Provided No Significant Pain Relief After Two Years Researchers Say: Do Not Give Cortisone For Knee Osteoarthritis

    In 2017, doctors from Tufts Medical Center in Boston asked, What are the effects of intra-articular injection of 40 mg of triamcinolone acetonide every 3 months on the progression of cartilage loss and knee pain in patients with osteoarthritis? Writing in the Journal of the American Medical Association, they published their answer:

    Among patients with symptomatic knee osteoarthritis, 2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain. These findings do not support this treatment for patients with symptomatic knee osteoarthritis.

    Does Molecular Weight Of Hyaluronic Acid Matter

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    Generally, molecular weight refers to how heavy the molecules of hyaluronic acid are. Hyaluronic acid can be high molecular or low molecular weight. High molecular weight only needs one injection.

    There is some debate about whether high or low molecular weight is better. Recent evidence suggests that high molecular weight hyaluronic acid is better. In addition, the Arthroscopy Association of Canada suggests that high molecular weight hyaluronic acid demonstrates a good effect on pain in knee and hip arthritis.

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    Cortisone Shot Vs Viscosupplementation

    A cortisone shot is a powerful anti-inflammatory that usually contains a corticosteroid medication and a local anesthetic. Viscosupplementation, on the other hand, is an FDA-approved procedure that involves injecting hyaluronic acid, a gel-like fluid, directly into a painful joint. Hyaluronic acid is naturally produced by your body and found in your joints. It helps reduce friction that can occur during movement.

    Viscosupplementation is specifically designed to supplement the fluid already present in your joint, thickening it and thereby providing the joint with more lubrication. This creates more cushioning, which improve your ability to move your knee joint without pain. Ongoing viscosupplementation injections can reduce the likelihood that you will need future knee surgery and is more effective the sooner you start treatment after your diagnosis.

    While you and your doctor will need to determine which injection is best for you based on the stage of osteoarthritis you have, here is how long each injection typically lasts:

    • Cortisone injections may provide temporary pain relief for anywhere from a few weeks to a few months
    • Viscosupplementation typically provides up to six months of pain relief, after which time the procedure can be repeated to keep arthritic pain at bay


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