Will It Fix Everything
Unfortunately, no. Hyaluronic acid injections wont cure all painful knee conditions. However, the injections can be extremely effective for osteoarthritis. Hyaluronic acid injections replenish the lining of your knees, which can provide pain relief for up to six months.
However, the treatment isnt as effective with other painful knee conditions, like ligament tears, tendinitis, or sprains. Hyaluronic acid injections restore the lining of your joints they dont repair your tissue.
Released: November 29 2022
At A Glance
- Compared to patients who received an injection of hyaluronic acid or no treatment at all, patients injected with corticosteroids had significantly more knee osteoarthritis progression.
- In one study, hyaluronic injections showed a decreased progression of knee arthritis, specifically in bone marrow lesions.
- A second study found that patients who received corticosteroid injections had significantly more medial joint space narrowing.
- RSNA Media Relations
CHICAGO Two studies comparing injections commonly used to relieve the pain of knee osteoarthritis found that corticosteroid injections were associated with the progression of the disease. Results of both studies were presented today at the annual meeting of the Radiological Society of North America .
Upasana Upadhyay Bharadwaj, M.D.
Osteoarthritis is the most common form of arthritis, affecting 32.5 million adults in the U.S. Knee osteoarthritis is a chronic, degenerative and progressive condition with an estimated incidence of 800,000 patients each year. More than 10% of patients with knee osteoarthritis seek noninvasive treatment for pain relief through corticosteroid or hyaluronic acid injections.
Researchers in both studies chose cohorts from the Osteoarthritis Initiative, a multicenter, longitudinal, observational study of nearly 5,000 participants with knee osteoarthritis currently in its 14th year of follow-up.
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.
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Common Questions About Hydrocortisone
Hydrocortisone injections contain the active ingredient hydrocortisone. This is a steroid .
The injection releases the hydrocortisone slowly into the part of your body that is painful or swollen. Like other steroids, it works by calming down your immune system. This reduces inflammation and helps to relieve the pain and swelling.
A hydrocortisone injection usually takes a few days to start working although sometimes they work in just a few hours.
If your pain and swelling gets better after a single hydrocortisone injection, you may not need another one.
If you have a long-term problem and hydrocortisone injections work well, you may carry on having them.
Doctors usually recommend waiting at least 3 months before having another hydrocortisone injection in the same joint.
The injection can be a little uncomfortable, but many people say they’re not as bad as they thought they would be.
Hydrocortisone injections usually help with pain and swelling for around 2 months. They can also make movement easier.
If you have a short-term joint injury, an injection will often help you start to move again so that your body can heal itself.
For long-term joint pain, an injection should help for a few months, but you may need further injections.
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Seeking Fast Temporary Relief From Knee Osteoarthritis
People may want temporary relief from knee osteoarthritis pain so they can postpone knee replacement surgery or pursue other treatments. Examples of treatments include participating in physical therapy to strengthen muscles around the joint or dieting to assist with weight loss, which relieves pressure on the joint. Other people may seek temporary relief so they can participate in a particular activity, such as a vacation that involves lots of walking or hiking.
Cortisone and hyaluronic injections are commonly used for fast, temporary relief from knee osteoarthritis pain.
Cortisone injections may begin working within 24 hours of the injection, and the effects of a cortisone injection typically last between 6 weeks to 6 months. The goal of a cortisone injection is to reduce inflammation, which is often the underlying cause of pain.
Hyaluronic acid injections tend to work more slowly than cortisonethe full effects may not be felt for about 2 weeksbut the effects may last longer. The primary goal of a hyaluronic acid injection is to lubricate the knee joint. This treatment is not always covered by insurance.
Some people who get cortisone injections experience a painful cortisone flare. A flare may last a couple of hours or a couple of days after the injection. Experiencing a cortisone flare does not mean that the cortisone injection will not work.
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How Do I Prepare For Viscosupplementation Treatment For Arthritis
Talk to your healthcare provider about all your medical conditions. Tell your healthcare provider about all the medicines you take, including over-the-counter medicines, like aspirin. Take all of your medicines as normal, unless your healthcare provider tells you otherwise.
The day of your procedure, you can eat and drink as you normally would. Tell your healthcare provider about any new symptoms, like fever. You may want to wear loose clothing so that you can easily expose your joint. Your healthcare provider might give you other instructions about what to do before your procedure.
Knee Injections For Arthritis: Which Is Best
Arthritis occurs when the cartilage of the joint wears away, exposing bone. This bone exposure leads to pain, swelling, and reduced function. Generally, simple treatments such as exercise, medications, and weight loss have the best effect on arthritis. However, we use knee injections for arthritis in London to help these simple treatments in complex cases. So, what are the options for knee joint injections, and how do you decide?
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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.
Stem Cell Injections For Arthritis In Knees
Stem cell therapy is becoming more popular as an injection in arthritis. These stem cells can change to other cells and regenerate new tissue.
Usually, stem cells are derived from various sources, including fat, bone marrow, and fetal tissue. The process of taking and processing these cells can be difficult and expensive. So, is the hassle and cost worth it?
Generally, the answer is no. While some smaller low-level studies show promise, higher-level studies show no difference between stem cells and cheap sterile water. So overall, we dont recommend you waste your money on stem cells until further evidence becomes available of effectiveness.
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Arthrosamid Injeciton For Knee Arthritis
Arthrosamid is a unique hydrogel of water molecules attached to a polyacrylamide backbone. The injectable is non-degradable, meaning the body does not break it down.
It works by coating the lining of the synovium of the knee joint, reducing inflammation, and providing lubrication.
Recent studies show improvement in pain scores lasting for up to 2 years. In addition, compared to hyaluronic acid, it works better in younger and slimmer patients.
How And When To Have Hydrocortisone Injections
A specialist doctor will usually give you your injection. This may be at your GP surgery.
If the injection is for pain, it may contain a local anaesthetic. You might also have a local anaesthetic by spray or injection to numb the skin before the hydrocortisone injection.
You can go home after the injection, but you may need to rest the area that was treated for a few days.
You may be able to have a hydrocortisone injection into the same joint up to 4 times in a year. The number of injections you need depends on the area being treated and how strong the dose is.
If you have arthritis, this type of treatment is only used when just a few joints are affected. Usually, no more than 3 joints are injected at a time.
The dose of hydrocortisone depends on the size of the joint. It can vary between 5mg and 50mg of hydrocortisone.
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Potential Risks Of Knee Injections
All knee injections come with potential risks of bleeding, bruising, swelling, and increased pain following the procedure. There is also a risk of developing an infection at the injection site. Always make sure to discuss the risks of knee injections with your healthcare provider before any procedure.
Bryngelzon / Getty Images
What Are Knee Injections
There are different types of knee injections. The most common type of intra-articular knee injection is corticosteroids. Other agents used are hyaluronic acid, infliximab, Botox , and platelet-rich plasma .
Knee pain can result from ligament or tendon injury, fracture, cartilage loss in osteoarthritis, and inflammatory conditions such as inflammatory arthritis or . Knee pain can also be due to joint malalignment or dysfunction and referred pain from other areas.
Diseases of the knee can be diagnosed based on
- clinical presentation,
- joint aspiration .
What If Knee Injections Dont Work
Knee replacement would be the last step in the treatment process for a patient with knee arthritis. However, this should only come after the patient has tried and failed with injections, bracing, NSAIDs, use of cane/walker, and most importantly a formal physical therapy program to maximize strength, motion, and weight loss, if necessary. When these treatments dont work, or stop working, then the patients options are to live with their current symptoms, or to proceed with knee replacement.
Knee replacement is the only thing that changes what the x-ray looks like and truly gets rid of the arthritis. All of the other treatments control the symptoms. The knee replacement is an open surgery where the ends of the femur and tibia, where the damaged cartilage is, are removed and metal caps are placed on the ends of the bone with a polyethylene spacer in between. This becomes the new knee joint. Patients nowadays typically go home the same day and are walking, with assistance, the day of surgery. Physical therapy ensues and patients typically recover in about 3 months. Knee replacement is a beneficial operation in the right candidate with typically 85-90% excellent outcomes.
A Third Option: Platelet
Some doctors are using this type of knee injection to treat knee OA symptoms. Doctors take your blood and collect the platelets, the part of blood that forms clots. They increase the number of platelets and inject them into your knee. Natural chemicals in platelets help heal injuries and lower inflammation.
Experts are still researching how well it works for osteoarthritis. It’s very expensive and still in early stages of research, Albayda says, so it’s not a mainstream form of OA treatment.
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Dextrose Prolotherapy And Saline Prolotherapy
Prolotherapy is the injection of an irritant solution into joints to stimulate natural tissue repair. Prolotherapy injections most often use a sugar solution or salt solution to temporarily:
- Improve strength, function, and mobility of the joint
- Increase the strength of ligaments, tendons, and other tissues surrounding the joint
- Reduce pain, stiffness, and inflammation in the joint
Prolotherapy typically involves multiple injections made during one treatment session. These treatments are given monthly over the course of several months, followed by as-needed injections. Fewer treatments may be required, depending on the individual and severity of their condition.
Healing time varies from person to person, but many people experience relief of painful symptoms within three to four days after the treatment. Because of the healing process, it may take up to a few weeks to experience full relief.
Prolotherapy injections are generally safe and come with few risks. However, the treatment may cause mild side effects, including:
- Infection at the injection site
- Pain, swelling, and stiffness in the area surrounding the injection
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.
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Why Might I Need Viscosupplementation Treatment For Arthritis
You may have already tried other treatments for your arthritis, like over-the-counter pain medicines and corticosteroid injections. If you still have significant symptoms, viscosupplementation might be a good choice to help reduce your pain, stiffness, and swelling. The treatment seems to work best in people with mild or moderate arthritis. The treatment may particularly make sense if you are trying to delay getting surgery on your joint.
Generally, healthcare providers use viscosupplementation to treat osteoarthritis, but the technique may also benefit people with certain other kinds of arthritis, like rheumatoid arthritis. You can talk to your healthcare provider about whether it is a choice for your type of arthritis.
Hyaluronic acid injection is not a treatment choice for arthritis in all types of joints. The knee is the standard injection site, but you might also be able to get it for arthritis in your hip or possibly in another location.
Cortisone Injections For Arthritis
Cortisone is the most commonly used injection. We know cortisone is a potent anti-inflammatory drug that reduces inflammation, swelling, and pain.
Overall, studies show short-term improvement in knee pain after a cortisone injection. Generally, the cortisone effect is better in milder knee arthritis cases and lasts up to 3 months. However, there is no difference between cortisone injections and placebo at six months for knee arthritis. Moreover, there are some concerns about cortisone injections for knee arthritis. For example, a recent study shows more cartilage wear after repeated cortisone injections. In addition, there is worrying evidence that having a cortisone injection could increase your risk of needing a joint replacement earlier. However, this evidence of needing a knee replacement earlier is not as strong. Therefore, we must do more studies to assess whether repeated cortisone injections harm joints.
Also, if youre planning on having a knee replacement, studies suggest you should avoid having a cortisone injeciton for up to 3 months before surgery.
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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, .
Are Cortisone Injections Good Or Bad For Arthritic Knees
TUESDAY, Dec. 21, 2021 — Cortisone injections have gotten a bad rap in recent years as a treatment for arthritis pain, because steroids are known to damage cartilage and could potentially cause the joint to further deteriorate.
Occasional cortisone shots don’t appear to cause knees to deteriorate any faster than injections of hyaluronic acid, a substance injected to lubricate joints stiffened by arthritis, the researchers said.
“Knee replacement rates were, if anything, a little bit less in the group that got the cortisone injections,” said senior researcher Dr. David Felson, a professor of medicine and epidemiology at Boston University School of Medicine.
However, Felson added that the study only looked at people who’d gotten infrequent cortisone shots to their knee, and shouldn’t be interpreted as giving the green light to regular injections for years to come.
“What we know from the study that we can trust is that a few cortisone injections won’t really cause much trouble,” Felson said. “It’s conceivable that repeated injections every three months for years won’t cause any trouble, but you can’t say that.”
“If you use it enough, it will damage the cartilage,” said Leber, who had no role in the study.
Comparing two types of shots
Unlike cortisone, hyaluronic acid gel isn’t harmful to cartilage.
Wise use is crucial
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