What To Expect After Corticosteroid Or Hyaluronic Acid Injections
Most people can return home or to work immediately after the injection takes place. The site of the injection may be swollen or tender for one or two days. Doctors may recommend applying ice two or three times a day or taking an over-the-counter medication to relieve pain and reduce swelling.
It may take several weeks to see improvement after a hyaluronic acid injection. Our doctors recommend restricting high-impact activity, such as running, until symptoms improve.
A person may feel the pain relief effects of corticosteroid injections more quickly than hyaluronic acid, but the results may not last as long. However, each person may respond differently to either of these injections.
It was the 50s when famous comedian, Jack Benny, received an award and opened his acceptance speech with, I dont deserve this award, but I have arthritis, and I dont deserve that either. Since then, advancements in medicine and technology have provided relief for millions of people with arthritis, but more than 100 different types of arthritis and related conditions still impact Americans today.
Bone Marrow Aspirate Concentrate Or Bone Marrow Concentrate Type Stem Cell Therapy
Using stem cells taken from a patients bone marrow is becoming a therapy of interest due to the potential of these mesenchymal stem cells to differentiate into other types of cells such as bone and cartilage. This is not a new revolutionary treatment, this treatment has been studied and applied for many years. It is a difficult treatment for some doctors to give. You do need experience in all aspects of the treatment to give the patient the best chance at achieving their healing goals.
Bone Marrow is the liquid spongy-type tissue found in the hallow of bones. It is primarily a fatty tissue that houses stem cells that are responsible for the formation of other cells. These mesenchymal stem cells , also called marrow stromal cells, can differentiate into a variety of cell types including osteoblasts , chondrocytes , myocytes , adipocytes , fibroblasts and others when reintroduced into the body by injection. Bone marrow also contains hematopoietic stem cells that give rise to the white and red blood cells and platelets.
Avoid Knee Replacement Surgery With Gel Knee Injections
If your knees ache, youre not alone. Over 50 million Americans have arthritis, and the knees are commonly affected joints. As the disease progresses, you may face the possibility of knee replacement surgery. Fortunately, theres another step you can take first. Minimally invasive gel knee injections may delay or eliminate the need for surgery.
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Types Of Gel Injections For Knees
There are several brands of hyaluronic acid for knee injections.
Consult with your physician about which brand of gel use for treatment. In some cases, it can be a single shot. Or you may have to get 3-5 injections spaced a week apart.
After receiving treatment, you should plan on limited weight-bearing activity for 1-2 days.
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 Do Gel Injections For Knee Arthritis Work
The active ingredient found in gel injections for knee arthritis is hyaluronic acid. Hyaluronic acid is produced naturally by our bodies. It is a key component of the lubricating synovial fluid found within many of our joints. In knees with osteoarthritis, the quality of hyaluronic acid decreases over time1. Low-quality hyaluronic acid affects the consistency of synovial fluid, reducing its lubricating and shock absorption qualities.
Synovial Fluid: Provides cushioning, supplies nutrients, and reduces friction between the surfaces of joints.
The main benefit of injecting hyaluronic acid into joints is greater lubrication. However, there are several other ways in which it may improve joint function1:
- Hyaluronic acid is anti-oxidative. This means it can combat the build-up of harmful substances in the knee joint.
- Hyaluronic acid may increase the knee joints ability to regenerate cartilage.
- Hyaluronic acid may reduce inflammation within the joint, relieving stiffness and pain from arthritis.
Hyaluronic Acid : HA is found all over the body. It serves a variety of functions from skin repair to wound repair. In our joints, HA increases the thickness of synovial fluid improving lubrication and shock absorption.
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.
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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.
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.
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Although Surgery And Cortisone Are Common Randomized Trials Have Failed To Produce Evidence For Their Effectiveness Or How Much They Do Work
Moving forward on that research, a February 2020 review study with the title Medical Reversals in Family Practice: A Review, published in the journal Current Therapeutic Research, Clinical and Experimental offered these points:
- Despite inconsistent recommendations for more invasive treatments, hundreds of thousands in the United States are treated with corticosteroid injections and surgery. Although these practices are common, randomized trials have failed to produce evidence for their effectiveness.
- Because corticosteroids have an anti-inflammatory effect and because osteoarthritis is an inflammatory condition, intra-articular corticosteroids have has been used for several decades, and as many as 95% of rheumatologists use them for osteoarthritis however, in a randomized trial of patients with symptomatic knee osteoarthritis, in which 140 patients were treated with an injection of either triamcinolone or saline every 12 weeks for 2 years, there were no differences in pain between patients treated with triamcinolone or saline. Further, patients assigned to the triamcinolone treatment had a greater loss in cartilage thickness. .
- Many patients are likely better off with a less-is-more approach of low-impact physical activity and strength training exercises than cortisone or surgery.
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.
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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.
Research Comparing Prp Bone Marrow And Adipose
A July 2020 study published in the journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, compared platelet-rich plasma , bone marrow aspirate concentrate, and adipose-derived mesenchymal stem cell injections in the treatment of osteoarthritis of the knee using functional scores.
- Methods: A total of 89 patients with painful knee osteoarthritis were included in this study.
- Patients were assigned to one of the 3 treatments according to the severity of osteoarthritis as indicated by symptoms and radiography to PRP , bone marrow aspirate concentrate , or adipose-derived MSC .
- Clinical assessment was performed using standard scoring systems, Surveys were completed at preoperative, and at 90, 180, and 265 days post-treatment.
Results: They all worked well.
- In a general statement, the PRP worked just as well in stage 1 knee osteoarthritis patients as the bone marrow aspirate worked in the stage 2 knee osteoarthritis patients and the adipose-derived stem cells worked for the stage 3 knee osteoarthritis patients. To quote the researchers: Our findings support previous reports and encourage further research on the use of these cost-effective treatments for osteoarthritis of the knee.
This is also a validation of our policy of not going straight to stem cell therapy in some of our patients. PRP or Prolotherapy, which is discussed below can provide equally good results without the added expense.
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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.
How Often Do You Need Knee Injections
How often you need a knee injection depends on several factors. Some of them include:
- Medical history
- Stage of your condition
- How long your relief lasts
A corticosteroid injection may provide relief for up to 24 weeks, while a hyaluronic acid injection may last 12 to 24 weeks. Corticosteroid injections can only be administered once every three to four months. Thats because they can break down your cartilage and come with possible side effects including high blood pressure, osteoporosis, and skin atrophy.
In comparison, hyaluronic acid injections may not work for everyone, and how theyre administered varies depending on the manufacturer. To determine the best solution for your osteoarthritis, talk to your doctor about the risks and benefits of each injection.
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Viscosupplementation For Knee Arthritis
When you have knee arthritis, it can be difficult to do every day activities like walking, going up and down stairs, and playing sports. At Ross Medical Group, our goal is to get you back on your feet so you can get back to doing the activities that you enjoy. If you are suffering from knee arthritis and have not yet found a helpful therapy, viscosupplementation injections may be for you. Our Sports Medicine specialist, David A. Ross MD, has been specially trained to administer viscosupplementation injections.
What is Viscosupplementation?
Viscosupplementation is a treatment option for those with arthritis of the knee. It is administered through a series of injections into the joint. It is believed that by replacing the thinned joint fluid of the arthritic joint by Hyaluronic Acid that lubrication will again be provided for the joint. Increased protection of the joint and decreased pain is the expectant result.
What is Hyaluronic acid?
Hyaluronic acid is a key component of the joint fluid. It gives the joint fluid its viscous, slippery quality, which helps to add cushion to protect your knee joint when you are on your feet. It also helps to enable the bones cartilage-covered surfaces to glide more smoothly against each other, thereby reducing joint friction.
How do the Injections work?
- Reduce the amount of pain in your knee
- Improve your range of motion and overall knee movement
- Slow down the progression of arthritis in the knee joint
How do I get these injections?
Why Dont Some Medical Groups Recommend Hyaluronic Acid Shots
Even though some patients have gotten relief from these shots, some professional organizations, such as the American Academy of Orthopaedic Surgeons, dont recommend them due to the lack of robust scientific evidence of their effectiveness. Some studies have found these injections are not more effective than placebo injections, Dr. Miller says. However patients get a lot of relief from placebo effects of any injection, so this makes it difficult to show the independent effect of the hyaluronan. In addition, given the expense of hyaluronan injections, he says, many insurance companies are reluctant to pay for something only a little better than placebo. I pay for them from Canada because my insurance wont cover, Quina told us on FB.
If youre interested in hyaluronic acid injections for your OA, talk to your doctor and check with your insurance company to see if they may be an option for you.
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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.
Amniotic Cord Blood And Placenta Tissue
There is a great amount of misinformation surrounding amniotic stem cell therapy, and umbilical cord blood stem cell therapy.We have never offered these treatments.
The primary reason we do not offer these products is that we did not find them to be more effective or economically viable to the patient than the utilization of the patients own stem cells and because we find simple dextrose Prolotherapy and Platelet Rich Plasma to be effective treatments which, in our observations, yield similar if not better results.
Amniotic stem cells marketed in many chiropractic offices are, in reality, micronized amniotic fluid. The micronization process takes amniotic fluid, freeze-dries it, and then processes it. The process kills the stem cells. NO live stem cells are present. However, growth factor remnants remain.
Many people attend webinars and seminars on the benefits of amniotic/placenta, umbilical cord stem cell therapy. These seminars are often conducted by a chiropractor whose presentation includes a segment on how the attendees of the seminar have joint pain because their own stem cells are too few, too weak, too feeble, and too old to repair the damage.
The great irony of this argument is if you have been told that your own stem cells are too few, too weak, too feeble, and too old, how does the amniotic tissue then work if it has no new stem cells in it?
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