Why Knee Injections?
Frequently Asked Questions
It’s natural to have lots of questions about joint care and our approach to health – especially if you haven’t been under principled joint care in the past. So, we’ve compiled some “Frequently Asked Questions” you might find helpful.
Knee injections are typically a two-part process. First, a numbing agent is used in the knee joint where the pain originates. This allows for a pain free experience. Next, a medication (most commonly hyaluronic acid, but could also be a steroid) is injected to block the pain. Our clinic focuses on improving the state of the joint using hyaluronic acid and PRP and opt for minimal steroid use as steroids further dry out the joint space.
Essence Med may recommend knee injections for many people who have been told they are a candidate for a total or partial knee replacement and are looking for non-surgical options to improve the state of their joint, people who are too young or wish to avoid knee replacement surgery, but who no longer get adequate pain relief from anti-inflammatory pain medications, physical therapy or lifestyle modifications.
For many patients, knee injections last anywhere from a few months to years, preventing or delaying the need for surgery. Some patients continue to benefit from knee injections for a year or more and continue to receive them on a schedule to maintain a comfortable lifestyle without need for surgery. For others, the injections will not provide an acceptable level of pain relief. For those patients, other treatments or surgery may be considered.
Knee injections are performed in an office setting rather than in a hospital or operating room. You may not want to perform any extreme physical activity after the injection as activity in the knee may reduce the effectiveness of the treatment. You may experience some mild pain and swelling around the injection site(s). You can use ice packs and over-the-counter pain medication for a few days after the procedure if needed.
Knee injections typically provide pain relief from six months to multiple years, depending on you and your pain tolerance.
Viscosupplementation refers to the injection of a hyaluronan preparation into the joint. Hyaluronan (HA) is a natural substance present in the joint fluid that assists in lubrication and over time as we age and use our joints, we produce less and less to aid in that lubrication process. HA allows smooth movement of the cartilage covered articulating surfaces of the joint. It is called viscosupplementation because this substance is intended to supplement the viscosity of your synovial fluid so it isn’t a dense foreign substance like some single shot gel injections may be. Hyaluronic acid also helps the body regulate inflammation.
We utilize an industry leading and FDA recognized hyaluronan preparation. It is indicated in the management of shoulder or knee osteoarthritis that has not responded to non-surgical treatment options such as pain medications, physical therapy and corticosteroid injections.
Hyaluronic acid injections provides symptomatic relief and delays or reduces the need for surgery. It is injected directly into the joint to replenish the diminished synovial fluid, thereby enhancing its lubricating properties. A single dose or a total of five separate doses, over several weeks, may be required for optimum benefit. This procedure thus improves the natural state of the joint, allowing it to move more smoothly. It is similar to a tire losing pressure over time within the joint space and pumping it back up with a fluid that replicates your body’s natural shock absorber.
Viscosupplementation injections not only supplements the hyaluronan in the joint but also stimulates the production of hyaluronan in the treated knee. This provides gradual symptomatic relief over the course of the injections by reintroducing what is naturally occurring and has diminished over time in the joint to help lubricate and stimulate production. This effect may last for several months.
Ice packs and an analgesic may be used, if required, to ease the discomfort. In addition, a brace is recommended to reduce pressure on the joint and allow space for the injection to have optimal impact. Any strenuous activity such as jogging or tennis should be completely avoided for 48 hours to a week after the injection and should be resumed only after consultation with your doctor.
You may experience mild pain, swelling, warmth and redness at the injection site for up to 48 hours following a Synvisc injection. Headache and joint stiffness may also occur in some cases.
Immediately consult your doctor if you develop fever or the pain and swelling fail to resolve after 48 hours following the injection.
The surgeon and staff draw blood – typically from the arm – and transfer it to special syringe device that allows us to centrifuge and separate out the blood platelets and plasma from the rest of the blood. The platelets are known to contain anti-inflammatory and growth or healing factors. PRP has anti-inflammatory capacity, which makes it good for arthritis management. The process of concentrating the plasma and platelets is performed right in the office. The surgeon then injects the PRP back into the site of pain, injury or osteoarthritis.
OrthoNebraska may recommend this treatment for active adults with knee arthritis or with acute muscle or tendon injuries. PRP injections are a newer treatment that have been tested extensively in large-scale trials, especially for osteoarthritis. These trials demonstrate both the safety and the effectiveness of PRP for knee arthritis. It is also helpful for certain tendon injuries including partial tears of patellar tendon, plantar fasciitis, and elbow tendinitis. However, insurance plans will not yet cover this type of new treatment. Currently, each injection costs $675 at OrthoNebraska.
Early research has demonstrated that PRP injections are effective for pain management and osteoarthritis. OrthoNebraska typically recommends PRP injections after an individual has not experienced the desired results from corticosteroid injections and/or hyaluronic injections. There is no higher risk of minor complications when compared to typical knee injections like cortisone. Individuals who are interested in PRP injections for arthritis or tendon injuries are encouraged to ask their orthopedic surgeon regarding this treatment opportunity.
PRP injections are performed in an office setting rather than the hospital. The injections may cause a temporary local irritation of 5-30 minutes, similar to knee injections. Ice packs or over-the-counter pain medication should suffice for treating any irritation.
Arthritis pain improvement occurs typically within a few days similar to cortisone injections.
It is not necessary to stop aspirin or other nonsteroidal anti-inflammatory medicines before or after PRP injections.