Chronic pain which comes from some form of arthritis, inflammation, or normal wear and tear. Patients who have been diagnosed with chronic chondromalacia may also find relief.
Pain from overuse can sometimes be treated with injection if rest and physical therapy fail to relieve the symptoms.
Knee injuries are not typical candidates for knee injections.
Joints normally have a fluid (called synovial fluid) that acts as a shock absorber. When the synovial fluid thins and loses its elasticity, the cartilage of the joint can wear down causing osteoarthritis pain. Viscosupplementation is designed to mimic the shock absorbing quality of healthy synovial fluid in the knee joints. This involves a preparation of Hyaluronic acid that is injected directly into the knee joint. Hyaluronic acid is a naturally occurring substance found in joint fluid.
Viscosupplementation has been shown to relieve pain in patients who did not get relief from other non surgical measures of treatment. This has been around in Europe and Asia for several years. The U.S. FDA approved it for use in 1997.
Here in the U.S. it is currently only approved for use in the knee, although other joints trial have been ongoing. Two preparations of Hyaluronic acid are available, a natural product made from rooster combs ( Synvisc) and an artificial one made from bacterial culture’s (Euflexxa) If you are allergic to egg or poultry products or have had a reaction with previous injections, the manufactured product should be used. Your Physiscian can help you make that decision.
People with OsteoArthritis usually have lower than normal concentration of hyaluronic acid in their joints. Viscosupplementation is most effective in the early stages of osteoarthritis, so be sure to discuss this option with your ProSports physician.
What to Expect
There are three injections. The injections are done once a week for three weeks. The injections are done in the office and take only a few minutes, with little to no pain.
Hyaluronic acid usually begins to work 3-6 weeks after the first injection. You should not expect immediate effects from the first injection. Typically most patients begin to feel less stiffness in their knee first (between 2-3 weeks). Anywhere from 3-6 weeks after the first injection their pain improves.
It should be noted that not everyone will get results from these injections.
About Steroid Injection
Intra-articular corticosteroid injections ( cortisone) are given to reduce moderate to severe pain. They can provide quick pain relief and reduce inflammation which in turn could help improve the quadriceps muscles functiion. However, the effects are not long lasting, possibly up to two months only. Typically no more than three or four injections should be given in a joint in a year. There is also the potential for long term joint damage with frequent repeated injections over a long period of time.
Upon occasion a combination of Viscosupplementation and Steroid can relieve a patients discomfort. You can discuss this option with your doctor.
Recovering from an Injection
Patients are able to return to their usual activity after the procedure, however aggressive exercise should be avoided for 24 hours after the injection.
Physical therapy is sometimes used as an adjunct to the treatment.
When the shots work they can provide relief for several months.
It is possible to repeat the injections if your physician feels you may benefit from a repeat course.
There is no proof that viscosupplementation injections will reverse the progression of osteoarthritis however it may play a role in delaying Total knee Surgery.
Pain, swelling of the knee although rare, are the most common complaints. These normally clear up with 24-48 hours with just some ice and advil. If severe swelling occurs you should return to the clinic as soon as possible.
Inject or not?
If your Boston Orthopedics and Spine physician has diagnosed osteoarthritis of the knee, and you haven’t found pain relief from physical therapy, application of heat and cold, or pain relievers such as Tylenol, then you should consider discussing injection options.