Our knees are complicated structures. Knee injections become necessary when the lubricating fluid in our knees – the hyaluronic acid – has decreased production and causes knee pain. Beth Orenstein wrote about this for Healthgrades.com, and we are happy to share some of her thoughts.
At the West Coast Center for Orthopedic Surgery and Sports Medicine, we often come across patients with knee pain in need of supplementary knee injections. What we often do first – after examining the patient thoroughly – is to prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to provide relief. We may take it a step further if the NSIDs are not successful, and after discussing it with the patient, we may recommend knee injections.
As Orenstein describes in her article for healthgrades.com there are two kind of knee injections. Viscosupplementation injections infuse your problem joint with synthetic hyaluronic acid. Depending on the product we may give you an injection once a week for three to five weeks. As part of your treatment, we will first remove any accumulated inflammatory fluid from your joint to allow the joint inflammation/swelling to decrease. Then we would move forward with knee injections.
According to the American Academy of Orthopaedic Surgeons (AAOS), you are not likely to experience pain relief immediately. You may even have some swelling, pain, and a feeling of warmth at the site of your knee injection.
AFTER KNEE INJECTION: STAY OFF YOUR FEET
But don’t worry, applying an ice pack will help, and your symptoms should go away quickly. For the first 48 hours, you should reduce your activities and avoid heavy lifting.
You should find that your pain lessens as you receive more injections. The maximum pain reduction effect and success takes up to six weeks. Hyaluronic acid is not an anti-inflammatory, but it may stimulate your body to make more of its own hyaluronic acid. It seems most helpful for those with early, mild-to-moderate knee conditions.
The other alternative knee injection is corticosteroids. Cortisone is a specific kind of steroid that your adrenal glands make naturally. These glands are located above each kidney. Cortisone decreases inflammation and, in turn, reduces pain.
Our own Dr. Keith Feder agrees with the notion that people with moderate to severe knee pain are most likely “candidates for corticosteroids”. According to the AAOS, corticosteroid injections are most helpful if you have a lot of swelling. They are not as useful if your osteoarthritis affects your joint mechanics—your ability to move.
Don’t get alarmed when the site of the knee injection becomes inflamed immediately after the injection. Icing and avoiding strenuous activity can help with cortisone injections as well to bring the swelling down.
While cortisone injections don’t have the same side effects as oral steroids, they still have risks. If you get too many injections, your good intact cartilage can soften and break down, causing more joint damage. For this reason, we limit the number of times you can have your knees injected. The AAOS recommends no more than four injections per joint per year.
SO, WHICH KNEE INJECTION IS BETTER?
As Orenstein notes, “both approaches have mixed reviews. A 2009 analysis of studies on both types of injections revealed that people had better initial benefits from the cortisone injections than from viscosupplementation. After four weeks, the results were about the same. At the three- and six-month marks, however, relief was better from the hyaluronic acid (viscosupplementation). “
Another analysis in 2012 offers a different viewpoint. It found that injections of hyaluronic acid have little effect on pain, and when they do, results start to fade after eight weeks. Doctors still don’t know the long-term effects of hyaluronic acid injections, and more research needs to be done in this area.
In the uncommon situation where going injections do not provide long lasting (up to six months) pain relief, utilizing a slightly different version of acid , very often results in successful pain reduction. At the West Coast Center for Orthopedic Surgery and Sports Medicine we look at each and every case individually. Only then will we make an assessment of which knee injection is best for you. Most important is this: If you experience knee pain, call and schedule a consultation. We are happy to help!