The Debate Over Hyaluronic Acid Injections And Knee Injections One Study Suggests That Hyaluronic Acid Is A Waste Of Time Money And Resources Another Study 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.
Reverse Injection: Fluid Aspiration
Fluid aspiration from a joint, called arthrocentesis, is the process of inserting a needle into a joint to remove excess fluid. The knee is the most frequently aspirated joint.
Joint inflammation and swelling that occur due to osteoarthritis can produce excess synovial fluid within the knee, restricting movement and causing increased pain. Removing the fluid by aspirating the joint with a needle can help reduce pain and improve swelling.
- Your healthcare provider may use a local numbing agent, such as lidocaine, either topically around the knee or by injecting it within the knee joint.
- A needle is inserted into the knee joint at either side of the patella, and a syringe is used to pull fluid out of the knee.
- Fluid aspiration may be performed by itself or prior to receiving another type of injection, and generally takes 30 minutes or less to complete.
- The numbing agent will typically wear off after two to four hours. It is common to have some pain or soreness for one to two days after the procedure.
Pain relief from fluid aspiration can last for six months or more.
While arthrocentesis is often performed for diagnosis and prior to joint injection, it is not typically used on its own for therapeutic purposes, as it does not fix the underlying issue that caused the joint effusion .
Where Are Steroid Injections Given
Its not like getting a flu shot, where you roll up your sleeve and present your arm. The steroid injection is given in the place where the pain radiates from. Locations such as the CMC , wrist, elbow, shoulder, knee, ankle, and big toe are common locations. For the spine and hip, doctors often use imaging, such as ultrasound for precise placement of the injection. This can help improve the accuracy of where the injection is placed, which can improve the effectiveness.
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Cortisone Can Make Bone On Bone Worse By Thinning Out The Meniscus But One Injection Appears Okay
One of the reasons that you are considering a knee replacement or are thinking about getting a cortisone injection is because you have been told you have a bone-on-bone knee. So the idea that cortisone may make this worse by thinning out your meniscus is concerning doctors.
In August of 2020 in the journal Scientific Reports doctors expressed concerns about damaging the meniscus tissue with cortisone injections. It should be noted that this researchs main findings were that it was okay to get one cortisone injection. For many people, one injection would be considered safe. Here are the learning points of that research:
- Although intra-articular corticosteroid injections are commonly used for the treatment of knee osteoarthritis, there is controversy regarding possible side effects on the knee joint structure.
- In this study, the effects of intra-articular corticosteroid injections on worsening the knee structure and creating greater pain were examined.
- Findings: No significant effect of the intra-articular corticosteroid injections were found on the rate of cartilage loss nor on any other knee structural changes or patient-reported pain scores. In conclusion, a single intra-articular corticosteroid injection for the treatment of osteoarthritis-related knee pain was shown to be safe with no negative impact on structural changes, but there was a transient meniscal thickness reduction, a phenomenon for which the clinical relevance is at present unknown.
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.
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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.
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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How To Prepare For A Cortisone Shot
If you take any medications that are classified as blood thinners, youll need to stop taking them for several days before getting a cortisone injection. This is to reduce the risk of bleeding and bruising.
Blood thinners include common painkillers such as NSAIDs like ibuprofen .
Make sure to speak to your doctor if you need to take any in the days before getting an injection as they can prescribe alternatives that will be better suited, such as acetaminophen .
Certain dietary supplements also have a blood-thinning effect, so inform your doctor of all medications and supplements youre taking. You can also ask your doctor to guide you as to what you should avoid before getting the shot.
While taking your medical history, your doctor will also ask whether youve had a temperature of 100.4 F or greater in the past two weeks.
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 .
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Corticosteroid Injections Can Help Relieve Both Inflammatory Arthritis And Osteoarthritis Find Out More If Theyre A Good Pain Relief Option For You
Remember the Carly Simon song I Havent Got Time for the Pain? She may have been talking about heartbreak, but arthritis pain is something you dont want to make time for either. When you have osteoarthritis or a type of inflammatory arthritis, such as rheumatoid arthritis or gout, you may get used to living with daily chronic pain, but when an acute arthritis flare occurs, it can really throw you off your daily routine and ability to work, be active, run errands, etc. Thats where corticosteroid injections come in a treatment option for acute bouts of pain.
Before Cheryl Ackerman was diagnosed with rheumatoid arthritis, she was experiencing pain so excruciating that she could barely walk, sit, or stand for any length of time. Per a doctors recommendation, she received corticosteroid shots in both of her knees, neck, and back. After about three weeks I finally felt the full effect by the inflammation going down and this gave me great relief, says Ackerman, who is from Florida. Even with the maintenance and pain, Ackerman says getting the injections is worth it. They have improved my quality of life living with rheumatoid arthritis immensely.
Steroid injections can relieve pain and improve mobility for many people, but they dont work equally well for all types of arthritis. There are also important precautions about how frequently you can safely receive them. Heres what you need to know before you face the needle.
How Knee Injections Work
First, your doctor will give you a shot of anesthetic to numb your knee.
Next, your doctor may use a needle to draw out any extra fluid that’s in your knee.
After that, you’ll get the pain-relieving injection, usually just below your kneecap. The shot shouldn’t hurt, and the drug will work throughout the joint, says John Richmond, MD, an orthopedic surgeon at the New England Baptist Hospital in Boston.
Different treatments have side effects that you should discuss with your doctor beforehand. The two most common types of knee injection for OA are corticosteroids and hyaluronic acid.
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How Do These Knee Osteoarthritis Injections Work
Normal joint fluid contains a substance called hyaluronan. It acts like a shock absorber and lubricant in your joint and is needed to help the joint work properly. Hyaluronan is highly viscous, allowing the cartilage surfaces of the bones to glide upon each other smoothly. This leads to decreased symptoms of osteoarthritis.
Prp Injeciton For Arthritis In Knees
Platelet-rich plasma is becoming more popular for treating arthritis and tendonitis.
We obtain PRP from whole blood. Then, we spin the blood to separate the plasma from red and white cells. Plasma contains a high concentration of platelets that are rich in growth factors. Finally, the plasma is injected into joints.
Overall, 23 studies show a good effect of PRP in knee osteoarthritis. Furthermore, comparing PRP to other injections such as hyaluronic acid reveals a better effect of PRP. We discuss PRP injections further in this blog.
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You Can Delay Knee Replacement Realistically For About 11 Months With Hyaluronic Acid Injections
In September 2020, a study in the journal American Health and Drug Benefits, assessed the value of intra-articular hyaluronic acid injections monetarily. This is a way to determine the effectiveness of the treatment. This is what the study said:
Although limiting hyaluronic acid use may reduce knee osteoarthritis-related costs, in this study hyaluronic acid injection only comprised a small fraction of the overall costs related to knee osteoarthritis. Among patients who had a knee replacement, those who received treatment with hyaluronic acid had surgery delayed by an average of 10.7 months.
Benefits Of Hyaluronate Injections
Hyaluronate injections offer a viable alternative to oral medications, which can have unwanted side effects or are completely ineffective for some people. If your arthritis does respond, the injections offer a very real solution to help you delay surgery or allow you to feel less pain as you wait for surgery to resolve your arthritis pain.
Some research also suggests that the injections can encourage your body to produce more of the substance naturally, which only helps keep remaining cartilage healthy and preserves knee function.
To learn about hyaluronate knee injections and other therapies for your knee pain, call Urgently Ortho in Scottsdale, Arizona, or book a consultation using this website. We strive to help people in the Phoenix area overcome pain and dysfunction in joints so they can resume a high quality of life.
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Cortisone Injections For Knee Arthritis
Cortisone injections work by treating the inflammation that can cause knee pain, swelling, and warmth. The effects of a cortisone injection can last from 3 weeks to 3 months, and occasionally longer.
People who want quick, temporary relief from knee arthritis pain may choose to have a cortisone injection. The temporary pain relief may allow a person to engage in physical therapy attend to an important life event, such as a long-planned vacation or postpone knee replacement surgery to a later, more convenient time.
Prolotherapy For Knee Osteoarthritis
In this video, Danielle R. Steilen-Matias, MMS, PA-C, of Caring Medical demonstrates how we treat a patient with a primary complaint of knee osteoarthritis.
- The person in this video is being treated for knee osteoarthritis as the primary complaint. The treatment takes a few minutes. The person in this video is not sedated and tolerates the treatment very well. For some patients, we do provide IV or oral medications to lessen treatment anxiety and pain.
- The first injection is given into the knee joint. The Prolotherapy solution is given here to stimulate repair of the knee cartilage, meniscal tissue, and the ACL as well.
- The injections continue over the medial joint line making sure that all the tendons and ligaments such as the medial collateral ligament are treated.
- This patient reported the greatest amount of pain along the medial joint line. This is why a greater concentration of injections is given here.
- The injections continue on the lateral side of the knee, treating the lateral joint line and all the tendon and ligament attachments there such as the LCL or lateral collateral ligament.
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What Does Cortisone Do
Cortisone, also known as a corticosteroid or a steroid, is a hormone your body naturally produces via the adrenal glands. When delivered as a medication, corticosteroids reduce the activity of your immune system, which relieves inflammation and pain for people with different kinds of arthritis .
Corticosteroids comes in many different forms, which vary by how long they stay in your body, how easily they dissolve, and how quickly they take effect. They can either be delivered locally , or systemically . Systemic corticosteroids are usually taken orally or as injections into a vein or muscle. Local corticosteroids for arthritis can be given as an injection into a joint for other types of health issues, they can also be delivered as skin creams, eye drops, or ear drops.