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.
Knee Gel Injections At Tampa Orthopaedic & Sports Medicine Group
Tampa Orthopaedic & Sports Medicine Group is the longest-operating orthopedic practice in the Tampa area. A division of Florida Medical Clinic, our center can be your first choice for osteoarthritis treatment, knee gel shots, and other progressive therapies from friendly, local physicians.
Our practice is led by orthopedic sports medicine surgeon Dr. Daniel Murphy and sports medicine physician Dr. Arnold Ramireztwo board-certified specialists who collaborate with other experienced clinicians to provide well-rounded care for a wide array of musculoskeletal conditions. Patients with osteoarthritis have access to knee gel injections from leading brands, including Synvisc One and Hyalgen, and attentive, personalized care from our experts. We make it a priority to educate our patients about all of their treatment options and help them make informed and confident decisions about their care.
Hyaluronic Acid Injection For Knee Osteoarthritis: Procedure And Risks
The injection technique for administering hyaluronic acid in the knee is called intra-articular injection. The term intra-articular injection refers to an injection given directly into the joint capsule.
This procedure is usually done in a doctors office and performed by an orthopedic physician. Some rheumatologists and primary care doctors may also provide this treatment. The injection procedure takes a few minutes and usually does not involve any prior preparation. It is however advisable to discuss the medical history and current medications with the doctor prior to this treatment.
The hyaluronic acid injection technique requires the expertise of a trained medical professional who can deliver the hyaluronic acid into the joint capsule of the knee.
The procedure for hyaluronic acid knee injections involves the following steps:
This injection technique requires the expertise of a trained medical professional who can deliver the hyaluronic acid into the joint capsule of the knee. If the material is injected in any other area of the knee, the effectiveness and safety of the procedure may be reduced.
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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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Hyaluronic Acid Injection For Joints And Tendons: Is It Useful
Arthritis and tendonitis is common in the general public. For those of us who are active in sport or running, arthritis and tendonitis can cause pain and swelling that stops us from taking part in these activities. Dr Masci has written a blog on effective treatments for arthritis. So, is a hyaluronic acid injection effective for arthritis and tendonitis?
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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.
What Are The Differences Between Gel Shots And Corticosteroid Shots
Corticosteroid, or steroid injections, are another treatment option recommended by the American College of Rheumatology to improve joint function. These injections include corticosteroid medication and a local anesthetic. They are most effective in treating inflammatory conditions, such as rheumatoid arthritis, bursitis, gout, plantar fasciitis, psoriatic arthritis, reactive arthritis.
Corticosteroids sometimes also referred to as cortisone injections can help relieve pain and reduce inflammation in the body including ankle, elbow, hip, knee, shoulder, spine, and wrist. Like gel shots, steroids are injected directly into the joint space and can reduce pain more quickly.
Steroid injections will provide more immediate relief from pain with a faster recovery, but the relief will be more short term.
Steroid treatment is used with caution for diabetes because steroids can raise blood sugar levels. Additionally, there could be an adverse effect of this treatment for prolonged use and to those allergic to corticosteroids. In these instances, viscosupplementation may offer an alternative treatment for joint pain relief.
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Gel Injections And Stem Cell Therapy
Stem cell therapyis an extremely exciting area of research that may one day change how knee osteoarthritis is treated. Currently, patient outcomes from stem cell therapy are inconsistent with respect to re-growth of healthy knee cartilage. Hyaluronic acid may one day be part of the solution. The combination of hyaluronic acid and stem cell therapies may be more effective than either treatment alone. Some studies have shown that combined therapies have increased the chance of rebuilding cartilage8. Hyaluronic acid appears to enhance the capacity of stem cells to form cartilage, allowing the treatment to become more effective. Clinical trials are currently underway for this combination therapy9.
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 all the tendon and ligament attachments there such as the LCL or lateral collateral ligament.
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What Are The Side Effects Of Hyaluronic Acid Shots
The shots are usually low risk, but some side effects may occur. Typical side effects include pain, swelling, heat, redness, and/or fluid build-up around the knee, Dr. Miller says. Rest and ice afterward can help prevent the typical side effects.
More rarely, infections of the joint are possible, as is damage to other parts of the knee, he says. However, properly trained physicians will deliver an injection with very little risk of complications, Dr. Miller says.
The Current Literature Demonstrates The Potential Benefits Of Utilizing Concentrated Bone Marrow Aspirate For The Repair Of Cartilaginous Lesions Bony Defects And Tendon Injuries
Doctors in New Jersey at the Department of Orthopedic Surgery, Jersey City Medical Center published their findings in support of this research, in the World Journal of Orthopedics, here is what the paper said:
- The current literature demonstrates the potential benefits of utilizing concentrated bone marrow aspirate for the repair of cartilaginous lesions, bony defects, and tendon injuries in the clinical setting. The studies have demonstrated using concentrated bone marrow aspirate as an adjunctive procedure can result in cartilage healing similar to that of native hyaline tissue, faster time to bony union, and a lower rate of tendon re-rupture.
A June 2018 study in the journal Arthritis and Musculoskeletal Disorders presents the short-term progress of 15 patients with knee osteoarthritis through four bone marrow concentrate treatments.
- Patients underwent four bone marrow concentrate treatments on average 14 days after 1st treatment, 21 days after the second treatment, and 33 days after the third treatment. The last follow-up was conducted on an average of 86days after the first treatment.
Patients experienced statistically significant improvements in active pain and functionality scores after the first treatment.
- On average, patients experienced:
- an 84.31% decrease in resting pain,
- a 61.95% decrease in active pain,
- and a 55.68% increase in functionality score at the final follow-up.
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Am I A Good Candidate
Like any treatment for knee arthritis, some individuals respond better than others. Approximately 50% of patients have a noticeable improvement in their knee function and pain after receiving gel injections3. Much research has been done to understand the characteristics of people who consistently respond well to gel injections for knee arthritis4.
If you are considering getting gel injections for knee arthritis, take a look at the candidacy checklist. This tool is based on a 2011 study4 reviewing past scientific research on the effect of hyaluronic injections on those with knee osteoarthritis. The better candidate you are the more likely you are to have a positive experience. If you want to learn more or feel like this treatment could be for you, discuss your specific situation with your doctor.
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.
When Prp Doesnt Work It Is Usually Not The Solution Used During Treatment But How The Treatment Itself Is Given
In the Journal of Knee Surgery, doctors at the Division of Sports Medicine, Department of Orthopedics, at Rush University Medical Center in Chicago wrote:
- Traditionally, treatment options have included lifestyle modifications, pain management, and corticosteroid injections, with joint replacement reserved for those who have exhausted nonsurgical measures.
- More recently, hyaluronic acid micronized dehydrated human amniotic/chorionic membrane tissue, and platelet-rich plasma injections have started to gain traction.
- PRP has been shown to have both anti-inflammatory effects through growth factors and stimulatory effects on mesenchymal stem cells and fibroblasts .
- Multiple studies have indicated that PRP is superior to hyaluronic acid and corticosteroids in terms of improving patient-reported pain and functionality scores.
- Unfortunately, there are many variations in PRP preparation, and lack of standardization is a factor.
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In The Past Your Doctor May Have Recommended Against The Use Of Cortisone Because It Was Clear To Him Or Her That There Was A Knee Surgery In Your Future
In the past, your doctor may have recommended against the use of cortisone because it was clear to him or her that there was a knee surgery in your future. The concern is if you get cortisone injections into your knee prior to surgery, you will have a greater risk of complications after the surgery. There is a lot of debate around this subject. Some doctors say avoid the cortisone, other doctors are saying it is okay to get one shot to hold you over until you can get surgery or maybe the cortisone will reduce your inflammation enough after the first shot that you will have some degree of pain relief and comfort for a few months, a year, maybe longer.
We are going to start with cortisone because cortisone was the injection of choice. Much has changed.
In a January 2021 paper from doctors at Northwestern University McGaw Medical Center, Rutgers School of Medicine, and Boston College, a current guideline was given for the use of cortisone: The paper appeared in the journal Pain Physician and included the following observations.
Ten Patients Underwent Intra
A September 2021 study published in The Archives of Bone and Joint Surgery was designed to compare the effectiveness of intra-articular injection of PRP with hyaluronic acid on mild to moderate knee osteoarthritis.
How the study was conducted:
- Ten patients underwent intra-articular PRP injection and 10 others received hyaluronic acid injection.
- At baseline visit and one, three, and six, and 12 months post-injection, clinical assessments were performed using standardized patient self-reporting scores for pain, function, and disability.
- Physical examinations of the knee, including crepitation and range of motion were performed at each visit.
- The PRP treatment was ascertained to be safe and caused no adverse effects. Significant improvements in the majority of patients were seen in pain and function.
- The hyaluronic acid injection, however, caused only one months significant improvement in the majority of patient-reported outcomes.
- In the majority of visits, the extent of improvements in pain and function were significantly greater in PRP recipients, compared to hyaluronic acid recipients.
- The ROM in both groups slightly increased after interventions.
- The frequency of coarse crepitation, which was detected in 100% of the patients in both groups at the baseline visit, decreased significantly to fine crepitation at the first follow-up visit in 80% and 40% of the PRP and hyaluronic acid recipients, respectively.
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How Is The Gel Shot Procedure Performed And What Can You Expect During Your Office Visit
During the procedure, you will be positioned in such a way that the affected joint is easily accessible. After the area around your joint is sterilized, a small amount of joint fluid will be removed before the actual injection to make room for the hyaluronic fluid.
We will use ultrasound imaging guidance to help localize and place the medication. By providing the gel shots to a region the medication has the potential to act as a shock absorber or lubricant. You may experience some pressure or slight discomfort. A small bandage will be placed over the injection site. You may receive a single treatment or weekly treatment for 3 to 5 weeks depending on the product used.
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.
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Likely Factors For Success
The people who do seem to respond best to hyaluronate knee injections are of normal weight and have only the beginning stages of osteoarthritis. The injections are most effective in people with just mild to moderate arthritis. If youre highly overweight or obese and have advanced osteoarthritis, the injections are less effective.
Hyaluronate injections also seem more effective on people younger than 65. If youve never had treatment with hyaluronate or steroid shots, youre also a better candidate.