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.
Before Taking This Medicine
You should not receive Gel-One if you are allergic to it, or if you have an infection in your knee or in the skin around your knee.
Gel-One is not approved for use by anyone younger than 21 years old.
Tell your doctor if you have ever had:
blood clots or circulation problems in your legs or
an allergy to birds, feathers, or egg products.
It is not known whether Gel-One will harm an unborn baby. Tell your doctor if you are pregnant.
It may not be safe to breast-feed a baby while you are using this medicine. Ask your doctor about any risks.
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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Comparing Botox To Other Treatments
A June 2019 study in the journal Clinical Rehabilitation compared the effectiveness of intra-articular injection of Botulinum toxin type A , triamcinolone hexacetonide , and saline in primary knee osteoarthritis. The study found the cortisone injections had higher effectiveness than Botox or the saline in the short-term assessment for pain in movement.
Differences Between Synvisc And Hyalgan
Even though theyre both made of hyaluronic acid produced from chicken combs, Synvisc is chemically modified to increase its molecular weight. Hyalgan is not.
Its thought that formulations with higher molecular weight are closer to the molecular weight and elasticity of the natural lubricants in the joints of young people.
However, whether Synvisc is more effective in people with OA hasnt been proven.
There are two Synvisc options. The newer option, Synvisc-One, is given as a single 6-millileter injection. The original Synvisc option is given as a 2-mL injection once a week for 3 weeks.
Hyalgan therapy requires one injection each week for 5 weeks.
All options can reduce OA knee pain for up to 6 months, but results from a 2005 study indicated that people using Synvisc could go longer between treatments than people using Hyalgan.
Understanding the possibility of complications and adverse effects is important in making any treatment decision. The side effects of the Synvisc options and Hyalgan are similar.
Possible side effects include:
- pain, redness, and swelling at the injection site
- fluid buildup around the joint
Repeat injections of Synvisc may cause a hypersensitivity reaction. This is a set of immune system responses to the product, including allergic responses.
This reaction may be uncomfortable or painful. Hypersensitivity reactions may happen after an injection even if they havent happened with previous injections.
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Gel Injections And Knee Bracing
Gel injections may be even more effective when combined with knee bracing. A study in 2015 followed 207 patients after they had received a series of 3 hyaluronic acid injections7. During the 6-month follow up period, half of the patients were equipped with a medial uni-compartment offloader knee brace . Patients with moderate knee arthritis saw improvements of 40% on average in their pain score. Those with mild knee arthritis saw a 20% improvement on average. The addition of a knee brace resulted in better outcomes for patients with severe knee arthritis. These results are encouraging as gel injections in isolation appear to be less effective for those with severe knee arthritis1. A similar synergy may also exist with knee bracing and stem cell therapy.
How Do Hyaluronic Acid Joint Injections For Knee Pain Work
In a normal, healthy joint, a fluid called hyaluronan provides lubrication. However, if you have osteoarthritis, there is less supply of this fluid. Hyaluronic acid joint injections supplement the joints hyaluronan with hyaluronic acid.
Its a simple procedure that is performed in the office, in which your doctor injects hyaluronic acid directly into the area around the joint. How often youll need injections will depend on the specific type of hyaluronan preparation used, but most people have one injection per week for three to five weeks.
If the treatment is effective, you may see results within daysalthough it may take more than one injection to make the pain go awayand the relief often lasts for several months. In some cases, your doctor may recommend repeat courses. At present, this treatment is only FDA-approved for people with osteoarthritis of the knee, though some patients opt to try the treatment on other joints.
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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.
What Is The Best Type Of Knee Injection
As you can see, there are many types of knee injections and they all have pros and cons. To the right I have compared them all on typical out of pocket cost, whether there is insurance coverage, and how much research there is at this point supporting that the procedure is effective. That indicator on the dial is placed to the right for lots of research and to the left for fewer or lower quality studies.
Based on the recent research showing that steroid shots breakdown cartilage and dont work as well as we once thought, they should be avoided. A hyaluronic acid is a reasonable option as its covered by insurance and doesnt harm cartilage.
PRP works better than HA in multiple studies, so if you have mild knee OA and dont mind spending out of pocket, its a good bet. Knee stem cell procedures based on bone marrow seem to work better in patients with more severe arthritis and may push the need for knee replacement down the road.
Finally, newer options like A2M or IRAP may also be options for less severe arthritis, but are more expensive than PRP and likely work about as well. Finally, there no data on exosomes, so I wouldnt waste your money at this point.
The upshot? There are lots of different types of knee injections, everything from the stuff insurance covers to other things that arent covered. These days orthobiologics are the new kids on the block that you should consider.
Chris Centeno, MD
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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.
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 doctor 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 .
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Do Injections Work For Knee Pain Don’t Waste Your Money
As spring turns into summer, we spend more time outdoors, exercising, gardening, or just walking around. And for many people, more exercise means knee pain. Count me among the afflicted.
Several people, including my orthopedic specialist, have suggested that I try injections of hyaluronic acid to treat my knee pain. Many people swear by it, and even though I looked into this two years ago , I thought I would look again. Perhaps the evidence had changed.
Superficially, these injections sound reasonable. Hyaluronic acid is already inside your knee and helps to lubricate and cushion the joint. Adding more lubricant seems like a good idea after all, it works for cars, bicycles, door hinges, or any other creaky joint.
But not for knees. Just recently, Anne Rutjes, Peter Jüni and their colleagues published a very large review of the evidence on knee injections. They looked at 89 trials involving over 12,000 adults and found that in the trials that were properly controlled , hyaluronic acid injections had either no effect or a clinically irrelevant effect that is, too small a difference to matter to the patient.
Rutjes and colleagues also pointed out that theres a real risk of harm when you inject something deep into the knee joint. To quote their summary for patients :
Viscosupplementation may provide little if no pain relief or function improvement in patients with knee osteoarthritis. It also seems to increase the risk for adverse events.
Is It Worth Getting Hyaluronic Acid Shots To Delay A Knee Replacement Should You Just Get The Surgery
Hyaluronic acid injections are often a last-ditch effort before knee replacement surgery. It bought me a year before replacements, Cathy Anderson Eberhardt told us on Facebook. But because the shots dont actually appear to affect the disease progression, some medical professionals think they just put off the inevitable, and only serve to tack on additional health care costs. For some people it can delay surgery or can avoid it altogether, but hyaluronans will generally not avoid eventual surgery in badly affected knees, Dr. Miller says. But, they will be helpful in patients not quite mentally ready for surgery.
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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.
Weak Warnings On Synvisc
Pseudosepsis is not listed as a side effect in Synvisc-Ones prescribing information.
I dont feel like I had enough information. I dont think the doctor was informed. She never would have told me to just use Tylenol or ice packs if she knew what the real dangers were, Julia said.
The Synvisc-One package insert mentions the symptoms of pseudoseptic arthritis, without ever mentioning the conditions name. Its part of a short, three-paragraph section on clinical trials for the gel.
Clinical benefit from the treatment may still be apparent after such reactions, the section concludes.
That was not Julias experience.
I still have pain, and Im still being treated, she told Drugwatch. And I can foresee that Ill probably need at least one knee replacement eventually. I know Ill never be the same.
*Name has been changed. Drugwatch is withholding this sources identity to protect her privacy.
Terry Turner has been writing articles and producing news broadcasts for more than 25 years. He covers FDA policy, proton pump inhibitors, and medical devices such as hernia mesh, IVC filters, and hip and knee implants. An Emmy-winning journalist, he has reported on health and medical policy issues before Congress, the FDA and other federal agencies. Some of his qualifications include:
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One Injection Just As Good As A Series Of Hyaluronic Acid Injections
The next stop will be a March 2019 study in the journal Current Therapeutic Research.
The question being asked here is maybe more than one injection would make the treatment more effective. In fact, the question is how this paper opens: Viscosupplementation of the synovial fluid with intra-articular hyaluronic acid is a well-known symptomatic treatment of knee osteoarthritis. The question arises whether a mono-injection could be as efficient as multi-injection regimens.
Here is how this paper concluded: In the symptomatic treatment of knee osteoarthritis with intra-articular hyaluronic acid, the results of mono-injections demonstrate to the multi-injections and also when compared to a placebo injection.
When Other Treatments Arent Working See If These Shots To Relieve The Painful Symptoms Of Knee Osteoarthritis May Be Right For You
Youve tried all the conservative therapies for your knee osteoarthritis, and nothing is working. You really, really dont want to go down the knee replacement surgery road yet. Whats left to try? You might want to consider hyaluronic acid injections for your knee osteoarthritis . Be warned, though: Their effectiveness is up for debate, with medical research not quite backing up how well they work.
Yet, individual patients have reported relief from their arthritis pain with the shots but not everyone. Even a CreakyJoints Facebook post soliciting feedback on patients experiences received responses ranging from they worked like a dream and amazing to they did nothing to relieve my OA knee pain and even they made my knee worse.
Read on to find out more and decide if hyaluronic acid injections are worth a shot for you.
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Study : Two Groups Of Patients One Group Gets Prp The Other Group Gets Cortisone How Did This Comparison Work Out
In an October 2020 study also comparing PRP and corticosteroid, similar findings were recorded. PRP results were better over time and the lack of side-effects should be considered if debating between one treatment or the other.
- In this study, the researchers found PRP had more significant values for improvement in comparison with corticosteroids, especially in the long-term .
- Both PRP and corticosteroid improved the functional and pain status in 30 and 180 days, but patients who had the PRP treatment showed a greater pain improvement.
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.
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