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.
Side Effects Of Injection Therapies
Side effects include a very low risk of infection and pain at the injection site. You also must stop taking oral anti-inflammatory medications for a short amount of time if you get a PRP injection, Dr. Genin says.
Often, many of these injections are effective in reducing or stopping your joint pain, but its important to remember that they may not keep the pain from returning, Dr. King notes. In fact, theyre most effective when used with other therapies. And we consider surgical options only if other treatment options have failed.
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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How Is Knee Injection Performed
Knee injection is a relatively quick procedure and may be performed under local anesthesia to avoid pain. A needle of appropriate size and length connected to a syringe is introduced into the joint and the medication is injected. Radiological guidance may sometimes be used to aid injection.;;
After the procedure, the patient would need to rest for a few minutes, and then they can resume normal activities. Patients may experience pain, swelling, and bruising, which resolve in a few days. Ice packs and pain killers can help reduce pain and bruising.
How Does A Hyaluronic Acid Gel Injection Work
We are not entirely sure but we have some ideas. One theory is that hyaluronic acid gel injection acts as a lubricant so the joint works more smoothly. Alternatively, we think that hyaluronic acid reduces inflammation in the joint and therefore joint pain and swelling. However, we are fairly certain that hyaluronic acid does not regenerate joint cartilage.
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Placental Tissue Matrix Injections
Placental tissue matrices are derived from the placenta, an organ that develops during pregnancy to provide oxygen and nutrients to a developing fetus. The placenta sends nutrients to the growing baby via the umbilical cord and it is delivered from the body during childbirth, along with the baby.
- The placental tissue is obtained from a healthy mother who had a normal labor and delivery without complications.
- Once harvested, the placental tissue is cleansed and preserved.
- The placental cells contain a large amount of growth factors that promote healing.
Similar to PRP injections, injections of placental tissue matrix have been shown to help heal damaged cartilage cells and delay changes to the cartilage in osteoarthritis.
You may experience decreased pain and improved use of your knee within two to six weeks after receiving prolotherapy injections, with effects lasting up to one year.
Neither injections of PRP or PTM are recommended for the treatment of knee osteoarthritis by the American College of Rheumatology and Arthritis Foundation guidelines because there is limited evidence demonstrating overall effectiveness and there is a lack of standardization of treatment protocols.
Cortisone Vs Hyaluronic Acid For Knee Pain: Which Is Better
In general, we know that cortisone injections improve pain and swelling in knee joint arthritis. However, the effect of cortisone is small and short-lived. Additionally, there are a number of concerns about side effects such as cartilage damage. Also, there are limits to the number of cortisone injections. Generally, we recommend no more than three injections into one joint over 12 months.
Hyaluronic acid gel injections offer a different option. Generally, hyaluronic acid injections take longer to work than cortisone but the effect is often longer-lasting up to 6 months. However, these shots are not for everyone. Research suggests that the evidence of effectiveness is mixed. They seem to work better for younger patients with less advanced arthritis. Moreover, older patients with more advanced diseases are less likely to experience relief.
There are different brands of hyaluronic acid that havent been shown to differ much. However, the larger-sized hyaluronic acid seems to work for longer. These include Durolane, Ostenil plus and Synvisc 1.
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Are There Any Side Effects
Side effects from hyaluronic acid injections are not common. Most are limited to the site of injection and do not last long. Tell your doctor if you are concerned about possible side effects.
Most common possible side effects:
Local side affects may include:
- redness and tenderness at the site of the injection
- increased stiffness, swelling or warmth inflammation lasting 24 to 48 hours following the injection.
These local reactions may be treated by resting and applying ice to the injected area or by simple pain relievers.
Less common or rare possible side effects:
These include:
- Allergy including rashes, hives, itching, flushing and swelling of the face, tongue or throat, chest tightness and shortness of breath. If you experience any of these symptoms contact your doctor straight away.
- Less commonly a joint may become severely inflamed after injection. This may be due to acute arthritis from crystals in the joint. Very rarely an infection in the joint may develop after the injection. If the pain and swelling in the joint that was injected increases a great deal or the joint becomes red and hot contact your doctor quickly.
- Other side effects that have been observed include headache, muscle pain, nausea, sore throat and flu-like symptoms.
Hyaluronic Acid Injection Treatment Protocol
In the past, multiple weekly injections were required for Viscosupplementation. With the advent of High Molecular Weight formulations- the injection stays inside the joint for much longer, and therefore a single injection is now used with up to 9 months of effect. Results indicate that the injections work well to control knee pain in particular, but many of these products now have general approval to be used in any synovial joint in the body.;
To ensure accuracy, Dr Samra uses image guidance with high-resolution ultrasound to inject the hyaluronic acid directly into the affected joint. A local anaesthetic is used before the injection.;
This medicine is to be administered only by or under the immediate supervision of your doctor, and all injections require a prescription.;
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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 remains.
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.
How Long Do Knee Gel Injections Last
Knee gel injections are a popular and FDA-approved treatment option among patients with osteoarthritisa very common degenerative condition characterized by the deterioration of cushioning joint cartilage. Also referred to as viscosupplementation, hyaluronic acid shots, and even rooster comb shots, knee gel injections involve administering hyaluronic acid directly into the knee to provide much-needed lubrication in the joint space and improve the knees ability to absorb shock. Hyaluronic acid is a naturally occurring substance that helps facilitate smooth, comfortable movement and can reduce the discomfort related to bone-on-bone contact from osteoarthritis. For some patients, knee gel injections may help delay or avoid the need for knee replacement surgery.
The effects of knee gel injections may last for about six months, with noticeable results typically occurring 4 or 5 weeks after treatment. This period of relief is considerably longer than other injection therapies. However, its important to note that every person is different. Results from knee gel injections can vary based on the severity of each patients arthritis and symptoms, as well as his or her overall health, age, and activity levels.
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The Efficacy Of Intra
An August 2021 paper from Department of Orthopaedic Surgery, Rush University Medical Center published in; The American journal of sports medicine compared the effectiveness of PRP against other knee injections in younger patients and those without severe degenerative changes. The reason? the efficacy of intra-articular injections as a nonoperative modality for treating symptomatic knee osteoarthritis-related pain while maintaining function has become a subject of increasing interest.
In this study the following treatments were compared:
- Hyaluronic acid.
- and plasma rich in growth factors .
Worth A Shot: How Helpful Are Knee Injections For Arthritis Pain
Nauman Akhtar, MD, is board-certified inorthopaedic surgery. He specializes in arthritis and joint replacement andserves as medical director of the Inova Loudoun Hospital Joint Replacement Program.
Knee painfrom arthritis can take a major toll, limiting your ability to do the thingsyou love. But few people are eager to undergo knee replacement surgery.
Many of mypatients ask about injections as an alternative to treat their knee pain. Thesecan be a big help, but its important to understand the pros and cons.
Cortisone Shots
Cortisoneshots are the traditional go-to injections for joint pain. They can be used inmost joints affected by arthritis, including the knee, ankle and elbow.
Cortisone shotswork by reducing inflammation caused by arthritis. They can be quite effectiveat reducing pain, but its a short-term fix. Relief typically lasts up to acouple of months, and sometimes only several weeks. However, some newertime-release varieties are becoming available, which can help extend therelief.
Cortisoneshots can only be given every four months. And each time you get an injection,it tends to be less effective. Still, many people find the shots relieve theirpain, and they are often covered by insurance.
Gel Shots: Hyaluronic Acid Injections
PRP Injections
Stem Cell Injections
When to Consider Knee Injections
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Caring Medical Research Case Studies
Our research team has published research on patient outcomes and case studies using bone marrow aspirate. Here is a sample of those outcomes. Again, we must remind you that this treatment does not work for everyone. Unfortunately, if you are reading this article you are probably very attuned to medical treatments that do not work.
In the medical journal;Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, our Caring Medical research team published our findings in seven patients. The patients who were treated for knee pain are featured below:
Patient case; Knee pain: A 69-year-old man
A 69-year-old male came into our office with pain in both knees, with his right knee significantly more painful. Pain resulted in frequent sleep interruption and limitation of exercise.
The patient had received prolotherapy at another office in the previous two years but felt that the treatment has reached its maximum ability to heal.
The patient was diagnosed with osteoarthritis and received five bone marrow/dextrose treatments in each knee at two-month intervals.
- Two months after the final treatment, the patient reported that he was completely free of pain or stiffness in both knees, had regained full range of motion, no longer suffered sleep interruption, and was no longer limited in exercise or daily life activities.
Patient case; Knee pain A 56-year-old woman
The patient received bone marrow/dextrose treatments;for six visits with 810 week intervals.
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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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.
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 lead 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 investigate 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.
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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.;
What To Expect After Corticosteroid Or Hyaluronic Acid Injections
Most people can return home or to work immediately after the injection takes place. The site of the injection may be swollen or tender for one or two days. Doctors may recommend applying ice two or three times a day or taking an over-the-counter medication to relieve pain and reduce swelling.
It may take several weeks to see improvement after a hyaluronic acid injection. Our doctors recommend restricting high-impact activity, such as running, until symptoms improve.
A person may feel the pain relief effects of corticosteroid injections more quickly than hyaluronic acid, but the results may not last as long. However, each person may respond differently to either of these injections.
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