Are Hyaluronic Injections Low
A research letter in the Journal of the American Medical Association Internal Medicine, with the title: Are Hyaluronic injections low-value health care? Using Medicare Data to Understand Low-Value Health Care: The Case of Intra-articular Hyaluronic Acid Injections, backed that up withbased on high-quality evidence that hyaluronic acid injections were not associated with clinically meaningful improvement in symptoms compared with placebo injections.
This statement paper is from 2014, lets see if we can advance the research forward towards 2021.
The first stop is February 2016 and the journal Clinical Orthopaedics and Related Research. It is an editorial from Seth S. Leopold, MD. Here are the quoted learning points:
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.
Growth And Healing Factors In Prp This Is What Makes Prp Work
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:
- PDGF initiates connective tissue healing through the promotion of collagen and protein synthesis.
- The primary effect of PDGF seems to be its mitogenic activity to mesoderm-derived cells such as fibroblasts ,
- Vascular muscle cells .
- Glial cells and chondrocytes .
- The most important specific activity of PDGF is the creation of cartilage.
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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Comparing Botox To Other Treatments
A June 2019 study in the journal Clinical Rehabilitation compared the effectiveness of intra-articular injection of Botulinum toxin type A , triamcinolone hexacetonide , and saline in primary knee osteoarthritis. The study found the cortisone injections had higher effectiveness than Botox or the saline in the short-term assessment for pain in movement.
How Long Will The Pain Relief Last
This can be difficult to determine for each patient, and there is no short answer. Each treatment can have a difference response and a different goal. Regenerative medicine treatments like stem cell therapy, PRP, and amniotic tissue injections can have lasting benefits that extend beyond 12 to 18 months. Viscosupplementation typically provides 6 months relief, while cortisone injections may provide a few weeks and sometimes months of relief.
In conjunction with these treatments, doctors further recommend that patients consider adjunctive treatments to encourage the efficacy of the knee injections, including:
- Weight loss
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When Are Knee Gel Injections Appropriate
Knee gel injections may be a viable treatment option for osteoarthritis patients with symptoms that do not improve with many common care approaches, such as:
- Nonsteroidal anti-inflammatory drugs and pain relievers
- Physical therapy
- Avoidance of high-impact activities
- Losing excess weight
If knee gel injections are considered appropriate for a patient, one to five shots may be administered over the course of several weeks. Patients are advised to avoid strenuous activities for 48 hours after each injection. Side effects are minimal, and usually involve temporary pain, swelling and warmth at the injection site.
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.
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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.
What Are The Side Effects Of A Cortisone Shot
Generally, cortisone shots are very safe if used for the right reasons.
However, like any medical treatment, there are always possible side effects. There is a very small risk of allergy, infection, and skin thinning. A cortisone shot can cause an increase in pain for the first few days. There is some worry about long-term side effects such as weakening of tendon strength or further joint damage. For example, recent studies suggest that repeated cortisone injections can damage cartilage. Moreover, a cortisone injection can weaken tendon strength for a few weeks. But we can reduce these concerns by using cortisone shots sparingly and for the right reasons. Also, using ultrasound to direct the injection into the right spot reduces the chances of a poorer result.
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What Happens After Viscosupplementation Treatment For Arthritis
You should be able to go home shortly after your procedure. Ask your healthcare provider if it is OK for you to drive. For about 48 hours, you should avoid standing for long periods, excessive walking, jogging, or lifting heavy weights.
Some people have slight pain, warmth, and swelling right after their procedure. These symptoms usually dont last long. Using an ice pack may help. Tell your healthcare provider right away if these symptoms dont go away soon, or if you have severe warmth, redness, pain, or high fever. Follow all your healthcare providers instructions about medicines and follow-up care.
Make sure to keep all of your future appointments. The procedure may not work effectively if you do not receive the full series of injections.
You should not expect your hyaluronic acid injection to relieve your symptoms immediately. It may take several weeks before you begin to notice a difference. Your relief from symptoms may last for several months.
If viscosupplementation is effective for you, you may be able to repeat the injection in 6 months or so. The procedure doesnt help everyone, though. If the procedure doesnt work for you, continue to talk to your healthcare provider about other treatment choices, like joint surgery.
How Are The Injections Performed
Although not mandatory, we feel that it is in the patients best interest to have HA injections done with some sort of image guidance. By using either ultrasound or fluoroscopy, we can verify in real time that the medication is, in fact, being injected into the affected joint and not simply into the soft tissue surrounding the joint. Sometimes people will report lack of efficacy with prior HA injections or severe pain with prior HA injections. Although not always the case, this can sometimes be due to the HA having been injected outside of the joint, where it has absolutely no chance of helping. Image guidance will not guarantee a positive outcome but it will minimize the chance that a patient will experience a false negative outcome.
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Different Types Of Knee Injections
Here are a few of the most common types:
- Corticosteroid When injected in the knee or other joints, Corticosteroid injections reduce pain and inflammation. These effects generally last for 2-3 months. A patient can only receive a limited number of these injections per year.
- Platelet-Rich Plasma PRP shots use a patients plasma to promote healing of the soft tissue and reduce inflammation. Doctors frequently use these injections to treat osteoarthritis, as they are low risk and have limited side effects.
- Hyaluronic Acid Injections or Viscosupplementation These are the technical terms for knee gel injections. As outlined above, a Hyaluronic Acid injection reduces pain and inflammation by mimicking the effects of natural joint fluid. They are best for patients with diabetes, as they do not raise blood sugar levels like Corticosteroid shots. Gel-One is one of the most commonly prescribed forms of HA treatment.
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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How Does Prolotherapy Work In Your Knees
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 27+ years of empirical observation of patient benefit.
In 2016, our Caring Medical research team published our study, A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain in the journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders. In this review, we examined the research in the use of dextrose Prolotherapy for the treatment of tendinopathies, knee and finger joint osteoarthritis, and spinal/pelvic pain due to ligament dysfunction. In our section on knee pain, we referred to a study by Dr. Fariba Eslamian and Dr. Bahman Amouzandeh of Tabriz University of Medical Sciences. This is what they published in the journal Therapeutic Advances in Musculoskeletal Disease.
Prolotherapy has been reported as a useful method in the treatment of chronic musculoskeletal and joint diseases. It is proposed that Prolotherapy causes mild inflammation and cell stress in the weakened ligament or tendon area, releases cytokines and growth factors and induces a new healing cascade in that area, which leads to activation of fibroblasts, generation of collagen precursors, and strengthening of the connective tissue.
Prp Is Not A Single Shot Miracle Cure Effectiveness Of Prp Is In How Many Times The Treatment Is Given
PRP is not a single shot miracle cure. While for the rare patient a single shot may work for them, we have seen in our clinical experience, PRP not to be as effective as a stand-alone, single-shot treatment. When someone contacts our center with a question about PRP, they understand the concept and that it should have helped them. But it did not. Why?
PRP does not work for every patient. The two main reasons are that some knees are indeed too far gone. What is typically too far gone? A knee that does not bend anymore or there is significant structural changes like bone spurs that have fused the knee.
The second reason is that they did not allow the treatment a chance to work. Many people think they are supposed to get immediate relief. That is not how PRP works.
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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, publishing in the journal Stem Cell International, found the injection of adipose-derived mesenchymal stem cell 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.
Can You Drive Home After Cortisone Injection
Firstly, you should wait at least 15 minutes after a cortisone shot before going home. Sometimes, injections make you feel dizzy or lightheaded. This effect is short-lived and settles after a few minutes.
Many insurance policies have strict rules on driving after a medical procedure. They require you to be able to apply an emergency brake when driving. So, as a general rule, we advise against driving after a cortisone injection into the hip, knee, or foot. However, cortisone injections into the shoulder, elbow, or hand can also stop you from driving properly. We suggest a friend or family member drives you home, or you take the tube or Taxi.
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What Are Synvisc Injections Used For
The joint also contains synovial fluid which lubricates the joint. With arthritis, the cartilage thins and frays and the synovial fluid loses its viscosity. This causes increased friction on the knee bones which results in pain. Cartilage has a poor blood supply which limits the healing process.
Synvisc injections help to improve the lubrication and cushioning of the knee joint caused by the cartilage damage. They help the knee bones and cartilage to move more smoothly which reduces pain. Its a bit like putting oil in your car to help lubricate it.
Hyaluronan also helps to reduce inflammation which can help to protect the remaining cartilage from damage. The overall effect of this is a reduction in knee pain which leads to improved mobility and function.
Synvisc injections tend to be given when other forms of treatment like medication andarthritis exercisesare no longer working adequately.
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.
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Rated For Osteoarthritis Report
Had both knees injections done on July 14, 2021. Next day both knees where swollen with fluid on my knees & couldnt walk. I wait till a week no change, contacted my Dr and immediately she had me come into the office to drain my knees & inserted cordisone. Next day my knees were normal again. I dont recommend this product.
Then Why Is Your Doctor Still Recommending This Treatment
Lets let Dr. Leopold continue:
One reason might be that surgeons have relatively few effective nonsurgical alternatives that help patients with their joint pain, andbeing members of a helping professionwe find this frustrating. However, our lack of effective nonsurgical treatments cannot justify the use of an ineffective one, and it must not be used to justify surgery unless surgery is indicated. Some patients will have pain that persists despite well-tested nonsurgical treatments, but not enough to warrant major joint surgery others may not fit the biopsychosocial profile that supports a decision to perform elective arthroplasty. The answer to this is not to use a treatment like viscosupplementation that studies suggest is ineffective, nor to take a chance on surgery when it seems ill-considered to do so, but rather to explain to patients that there are some problems for which we have no effective treatments, and to help those patients adjust and adapt.
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