Are There Alternatives To Cortisone Injections
Yes. Recent studies suggest that other injections can be helpful for arthritis and tendonitis with potentially fewer side effects.
Hyaluronic acid is a natural substance in normal joints and tendons. There is some evidence that hyaluronic acid injections provide longer pain relief in arthritis than cortisone. Also, we use hyaluronic acid for injections in plantaris-associated Achilles tendonitis.
Platelet-rich plasma is obtained by spinning whole blood from a patient. The plasma, which contains a high concentration of platelets and growth factors, is injected into tendons and joints. There is good evidence that PRP provides long-term pain relief for knee arthritis and some tendons. You can read more about the positive effects of PRP on arthritis and tendonitis. We have also written a blog on PRP injections for knee arthritis.
Finally, recent evidence suggests that combining the two hyaluronic acid and PRP might be better.
Successful Safe And Encouraging Results
A January 2020 study published in the journal Knee Surgery, Sports Traumatology, Arthroscopy found:
Pre-clinical studies have demonstrated successful, safe and encouraging results for articular cartilage repair and regeneration. This is concluded to be due to the multilineage differential potential, immunosuppressive and self-renewal capabilities of bone marrow derived mesenchymal stem cells, which have shown to augment pain and improve functional outcomes.
What Is Hyaluronic Acid And What Does It Do
Hyaluronic acid, also known as hyaluronan, is a gel-like substance naturally present in the synovial fluid that lubricates your joints. Because arthritis patients lose hyaluronic acid as their joint wears away, the theory goes that replacing it with a process called viscosupplementation would make using the joint less painful. The injections are FDA-approved for knee osteoarthritis.
Its mechanism of action is not fully known, but is thought to at least temporarily increase the viscosity, or thickness, of the fluid that surrounds the joint it is injected into, says Donald Miller, PharmD, a professor at the School of Pharmacy at North Dakota State University. This may reduce pain and make joint movement easier.
You can think of it like WD-40 for your joints.
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Why Would I Need Knee Injections
The doctors at OrthoNeuro include knee injections in treatment plans for various injuries and degenerative conditions, including:
- Osteoarthritis
- ACL tears and other ligament injuries
- Meniscus tears
- Sprains
Ultimately, the goals of knee injections are to relieve pain, facilitate healing, and help you get back to your regular activities.
In Clinical Observations At Caring Medical Great Benefit Is Seen In Injecting Bone Marrow Directly After Extracting It
The theory is that the number of stem cells is not as important as how long they live in their natural environment. In other words, when the bone marrow is directly injected, the source of stem cells is fresh and has great potential for healing. We also believe that the body knows best it can use these immature cells to regenerate all injured tissues in the joint.
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What Conditions Do Cortisone Shots In The Knee Work For
Corticosteroids are used to treat a variety of knee conditions such as tendonitis, bursitis, and osteoarthritis .1 The first thing to note is that they are not considered a permanent solution. Corticosteroids can provide short term relief from knee pain but over time the beneficial effects will wear off. Because of this, the utility of corticosteroid injections is very situational. Professional athletes will often get injections to make it through key games during their season. Someone planning a long multi-week vacation may receive an injection to maximize mobility during their leisure time. Regardless of the cause of your knee pain, you should weigh the pros and cons of cortisone injections before deciding on treatment.
Learn more about other treatments for knee arthritis
How Fast Cortisone Works
Cortisone shots work by decreasing inflammation. Many patients mistakenly think that cortisone only serves to cover up the pain. That’s not really true.
Cortisone can be a very effective method to reduce the inflammation caused by a variety of common orthopedic conditions including tendonitis, bursitis, and arthritis. Once the inflammation subsides, pain relief follows.
Cortisone starts to work immediately following the injection, and inflammation usually begins to subside within a few days. Depending on how quickly the inflammation subsides, the timing of pain relief can vary from a few days to a few weeks.
Most people who have a cortisone shot, and find relief from the injection, will describe the gradual reduction in symptoms over a span of days to weeks. However, the amount of inflammation, the type of injection administered, and other factors can all affect the length of time it will take before you experience relief.
If the inflammation is severe, or if the inflammation has been around a long time , the cortisone injection may take longer to take effect and may require more than one injection.
Not every patient will respond to a cortisone injection, but the good news is that most people find this to be an excellent treatment for many common inflammatory conditions.
If your shot hasn’t worked after a few weeks, let your doctor know so that you can discuss the next steps in treatment.
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Reduce Inflammation With Steroids
Corticosteroid injections are useful for treating flare-ups of OA pain and swelling with fluid buildup in the knee, Richmond says.
These injections help relieve symptoms by reducing inflammation in the joint. But theyâre not a perfect solution in every case. If you’re considering this treatment, keep this in mind:
They work quickly. These injections offer âvery rapidâ relief, usually within 24 to 48 hours, Richmond says.
The benefit is short-term. On average, the pain relief lasts from 6 to12 weeks, Richmond says. Often, thatâs long enough to get you through a flare-up of osteoarthritis until your symptoms subside.
You shouldnât use them frequently. A corticosteroid shot often works best the first time, Altman says. After that, they tend to give less relief.
In most cases, Richmond tells his patients they can use these shots two to three times a year. Using them too often may damage cells in the knee that make cartilage.
How Is Needle Placement For Genicular Nerve Injection Done
The needle placement for genicular nerve injection is made under fluoroscopic guidance with reference to bony landmarks. Objective: To investigate the anatomic landmarks for medial genicular nerve branches and to determine the accuracy of ultrasound-guided genicular nerve block in a cadaveric model.
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Another Study Suggests: Repeated Courses Of Treatment With Hyaluronic Acid Are Safe And Are Associated With The Delay Of Total Knee Replacement For Up To 3 Years
A July 2018 study in the American Journal of Orthopedics recognized that for some people: Total knee replacement is a significant procedure with potential risk for serious complications and high costs. Alternative lower risk therapies that can delay or total knee replacement are valuable to those who are poor candidates for surgery or wish to avoid total knee replacement as long as possible.
Are Hyaluronic Acid Injections the answer? Here is what the study concluded:Repeated courses of treatment with Hyaluronic Acid are safe and are associated with the delay of total knee replacement for up to 3 years. So again, we have a three-year delay after repeated courses of Hyaluronic Acid injections supported in the research. But what about the study that says Hyaluronic Acid Injections that delay inevitable knee replacement are a waste of time, money, and resources?
Cortisone Shots In The Knee Do They Really Work
Are you considering getting cortisone shots in your knee? Although cortisone injections have been used for the past fifty years, some physicians are concerned that they may have adverse long-term side effects. Despite this, many patients experience significant pain relief from corticosteroid shots depending on your circumstances this treatment may be right for you.
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Although Surgery And Cortisone Are Common Randomized Trials Have Failed To Produce Evidence For Their Effectiveness 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.
The Debate Over Hyaluronic Acid Injections Knee Injections One Study Suggests That Hyaluronic Acid Is A Waste Of Time Money And Resources Another 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.
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How Long Does Relief Last
It is quite variable but many patients report six months of relief, and the injections may be repeated every six months or based on physician judgement, Dr. Miller says. Our Facebook community confirms this, with most patients telling us relief lasted from four to six months they got the shots every six months. But, as Sarah Quina shared, they dont work repeatedly forever. Also, the shots may take several weeks to go into effect, unlike steroid injections, which work much faster.
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 Is A Prp Injection
When a PRP injection for knee arthritis is performed, we take a small sample of your blood, and we place that sample into a centrifuge. The centrifuge will separate your blood into many different components. Towards the bottom of the tube we will find your PRP layer. We carefully remove that layer of PRP from the tube and place it into a syringe. After we clean and sterilize a small area of your knee we will numb the skin. Once the skin is numb we will inject the PRP into your knee. This is typically a 30 minute office visit.
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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.
Two Groups Of Patients One Group Gets Prp The Other Group Gets Cortisone How Did This Comparison Work Out
In this study from The Journal of Sports Medicine and Physical Fitness, a comparison is made between the effects of a one-time injection of PRP and corticosteroid for the patients suffering from osteoarthritis.
- Patients suffering from Grade II or Grade III knee osteoarthritis were randomly divided into two groups: intraarticular injection of PRP and cortisone.
- Forty-one participants were involved in the research .
Compared to the group treated with corticosteroid, PRP showed significant results for:
- pain relief
- being symptom-free
- activities of daily living and quality of life
This study demonstrated that one shot of PRP injection, decreased joint pain more and longer-term, alleviated the symptoms, and enhanced the activity of daily living and quality of life in short-term duration in comparison with the corticosteroid.
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Mayo Clinic And Yale University Studies On Your Own Bone Marrow Stem Cells
Doctors at the Mayo Clinic and Yale University published their research on the benefits of Bone Marrow Aspirate Concentrate for Knee Osteoarthritis in the American Journal of Sports Medicine. Here is the summary of that research:
- In their single-blind, placebo-controlled trial, 25 patients with bilateral knee osteoarthritis were randomized to receive Bone marrow aspirate concentrate into one knee and saline placebo into the other. Early results show that Bone marrow aspirate concentrate is safe to use and is a reliable and viable cellular product. Study patients experienced a similar significant relief of pain in both bone marrow aspirate concentrate- and saline-treated arthritic knees.
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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How Long Does A Cortisone Shot Last
Learn about the factors affecting how long cortisone shot pain relief lasts.
When inflammation caused by arthritis makes joints painful and daily activities difficult, a cortisone shot can be an important tool in your treatment plan. This treatment delivers medication directly to the inflamed joint to suppress localized inflammation. However, it is important to understand that cortisone pain relief is temporary, and that cortisone injections do have limitations.