Are There Any Precautions For Ha Injections
There are few side effects to hyaluronic acid joint injections, although some people do have a mild reaction that causes temporary pain and swelling in the joint. It is, however, important to not strain the affected joint after receiving the injections. You should avoid any strenuous activitiessuch as jogging, tennis, heavy lifting or even being on your feet for long periodsfor two days after the treatment.
Dr. Ackerman will closely monitor your progress while you receive injections. This will allow him to see whether the treatment is working properly and to decide whether you should continue. If you experience pain or swelling that doesnt go away, you should notify Dr. Ackerman.
The Cortisone Debate Goes On
A December 2020 study published in the medical journal Rheumatology gives this overview assessment of the debate surrounding the use of cortisone for a bone on bone knee. Here are the summary learning points:
- Existing data indicate that intra-articular corticosteroids in knee osteoarthritis provide short-term pain relief and functional improvement which may last from one to several weeks.
- At present, synovitis is the most important predictor of treatment response, and also a target for anti-inflammatory treatment for intra-articular corticosteroids.
- Our explanatory note: If you have a lot of knee swelling cortisone maybe be of benefit. Please see our article treating chronic knee swelling.
Returning to the research study:
- subgroup of patients with the inflammatory phenotype with clinical features of pain, stiffness, joint swelling, and effusion are expected to be more responsive than other phenotypes who do not display clinical manifestations of inflammation.
- Our explanatory note: If you do not have chronic knee swelling, cortisone may not be an answer for you.
Returning to the research study: In some people swelling comes and goes, it is hard to suggest who cortisone would be successful for among these people.
Returning to the research study: The more suitable cortisone patient is:
The evidence then was a summary of the effects of cortisone on articular cartilage which included:
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.
It hadn’t.
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.
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What Are Hyaluronic Acid Joint Injections
Hyaluronic acid is similar to a substance that occurs naturally in the joints, and acts as both a lubricant and a shock absorber, helping the joint to work properly. Hyaluronic acid injections, also known as HA injections or gel injections, are used to treat knee pain in people with osteoarthritis of the knee for whom other treatments have been unsuccessful.
Knee Pain Treatments Depend On Severity Of Pain And Damage
Knee pain can take many forms. It may be a sharp pain, achiness, a dull burning sensation, or uncomfortable swelling or stiffness. The pain may be worse at night, and the knee may feel unstable.
About one in four Americans lives with chronic knee pain that limits their function and mobility and interferes with their quality of life. The most common cause of knee pain? Osteoarthritis. In this progressive form of arthritis, the cartilage that cushions the ends of the bones in the knee joint wears away over time.
Knee pain treatments depend on the severity of the pain and how advanced the damage is. Mild pain may be managed with over-the-counter, non-steroidal anti-inflammatory drugs , such as ibuprofen or naproxen , along with physical therapy or a supportive knee brace. More significant pain may require medical treatment, especially if it affects your work, exercise or everyday activities.
Types of knee injections for pain
If more conservative treatments arent effective, your doctor may recommend injections to relieve discomfort and restore your normal function.
There are several types of injections to reduce inflammation in the knee joint, which can help with pain and mobility for several months or more, says Jeffrey Wilde, MD, an orthopedic surgeon with Scripps Clinic. The right choice is determined by your symptoms and your individual medical profile.
Corticosteroids
Hyaluronic acid injections
Platelet-rich plasma injections
Knee replacement surgery
Related tags:
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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.
How Effective Are Hyaluronic Acid Injections In Remedying Chronic Knee Pain
Maybe your knee pain is worse when you wake up in the morning and are just starting to move around for the day. Or perhaps, by the end of the day, your knees are screaming for relief. Whatever your experience with knee pain, we know you want effective relief now.
Our anesthesiologist and pain management expert Syed Nasir, MD, here at Skilled Pain Care Clinic, PA, in Houston and Katy, Texas, offers an expert diagnosis of the many conditions and injuries that can cause knee pain. He creates personalized treatment plans to reduce your pain quickly and heal the underlying condition for long-term relief.
One of the many treatments available are hyaluronic acid injections, but are they useful for all types of knee pain?
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Is Prp Controversial Yes Is It Effective Also Yes
When it works. Below are many citations and references showing the effectiveness of PRP.
Lets start with the most recent research of the effectiveness of PRP for knee osteoarthritis.
- While an October 2020 study in The Journal of International Medical Research still acknowledges that the clinical efficacy of platelet-rich plasma in the treatment of osteoarthritis remains controversial, their examination of five clinical trials including 320 patients found: intra-articular injection of PRP is an effective treatment for osteoarthritis that can reduce post-operative pain, improve locomotor function, and increase patient satisfaction.
- This is a June 2020 study from the journal Clinical Rheumatology, Here researchers suggested that Intra-articular PRP injection provided better effects than other injections for osteoarthritis patients, especially in knee osteoarthritis patients, in terms of pain reduction and function improvement at short-term follow-up. .
- In a study published in the American medical journal Arthroscopy, medical university researchers suggested that PRP injections were more effective in the treatment of knee osteoarthritis, in terms of pain relief and self-reported function improvement at three, six, and twelve months follow-up, compared with other injection treatments. We are going to show the comparative research below.
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.
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Gel Injections For Knee Arthritis
Stiff and sore joints are a reality for most of us as we get older. Normally, our body secretes natural lubricants that reduce friction between the joint surfaces. Knee osteoarthritis increases friction in the joint causing the protective layers of cartilage on joint surfaces to slowly break down. Gel injections for knee osteoarthritis contain hyaluronic acid which can provide relief by improving joint lubrication. Treatments aimed at decreasing joint friction are also known as viscosupplementation. According to experts12, if youve tried exercising, dietary changes, and other painkilling drugs with no success, this treatment could be for you.
Viscosupplementation: Injecting lubricating substances into a joint with the goal of increasing function and decreasing pain.
Who Is A Good Candidate For Knee Therapy
If youre tired of taking prescription medication or over-the-counter painkillers to treat your knee arthritis with limited effectiveness, gel injections could be right for you. Good candidates for knee therapy experience moderate to severe knee pain when walking, climbing flights of stairs, or playing sports. To be eligible, you should have no significant mechanical or alignment issues with your knees, which can only be corrected with surgery.
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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.
Study: A Comparison Between Prolotherapy Botox Physical Therapy And Hyaluronic Acid Injections
Here we have a September 2020 study published in the International Journal of Rehabilitation Research. In it, researchers compared the effectiveness of four treatments in the management of knee osteoarthritis.
- In total, 120 patients with knee osteoarthritis, all over the age of 50 years of age were randomly allocated to four groups.
- The test results were based on pain and functional scoring systems.
- Exercise recommendations were prescribed daily for all participants throughout the study.
- For physical therapy , participants received superficial heat, transcutaneous electrical nerve stimulation, and pulsed ultrasound.
- Botox: Researchers administered a single intra-articular injection of botulinum neurotoxin type A
- Hyaluronic acid: Researchers administered three injections of hyaluronic acid
- Prolotherapy: Researchers administered 20% dextrose to patients in the corresponding groups.
Findings:
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Cortisone Knee Injections: In The Past Your Doctor May Have Recommended Against The Use Of Cortisone Because It Was Clear To Him Or Her That There Was 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.
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.
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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.
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?
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Side Effects And Risks Of Hyaluronic Acid Injections For Knee Osteoarthritis
Hyaluronic acid injection for the knee is usually considered a safe procedure, but like any medical procedure, it may carry some side effects and risks.
The most common side effects of this procedure include mild swelling and pain at the injection site.
Risks, although rare, may include pseudo-septic arthritic reactions.6,7 Pseudo-septic arthritis is a severe inflammatory reaction or flare at the injection site. If this reaction occurs, it is usually seen within the first three days of injection and may be treated with non-steroidal anti-inflammatory drugs or steroids.7
Other rare risks include infections, allergic reactions, or bursitis. If such signs or symptoms occur, it is advised to see a doctor immediately.
See Knee Bursitis and
What Happens After Viscosupplementation Treatment For Arthritis
You should be able to go home shortly after your procedure. Ask your healthcare provider if it is OK for you to drive. For about 48 hours, you should avoid standing for long periods, excessive walking, jogging, or lifting heavy weights.
Some people have slight pain, warmth, and swelling right after their procedure. These symptoms usually dont last long. Using an ice pack may help. Tell your healthcare provider right away if these symptoms dont go away soon, or if you have severe warmth, redness, pain, or high fever. Follow all your healthcare providers instructions about medicines and follow-up care.
Make sure to keep all of your future appointments. The procedure may not work effectively if you do not receive the full series of injections.
You should not expect your hyaluronic acid injection to relieve your symptoms immediately. It may take several weeks before you begin to notice a difference. Your relief from symptoms may last for several months.
If viscosupplementation is effective for you, you may be able to repeat the injection in 6 months or so. The procedure doesnt help everyone, though. If the procedure doesnt work for you, continue to talk to your healthcare provider about other treatment choices, like joint surgery.
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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.