Treating Knee Osteoarthritis With Hyaluronan Injections

Written by WebMD Editorial Contributors

• How Do These Knee Osteoarthritis Injections Work?
• What Joints Can Be Treated With These Osteoarthritis Injections?
• Candidates for Knee Osteoarthritis Injections
• Side Effects of Knee Osteoarthritis Injections
• What to Expect From Knee Osteoarthritis Injections

There are several versions of hyaluronan injections — also called viscosupplementation — that are used to treat knee osteoarthritis. They are injected directly into the joint. They include:

• 1% Sodium hyaluronate (Euflexxa,)
• High-molecular-weight hyaluronan (Orthovisc)
• Hylan G-F20 (Synvisc)
• Sodium hyaluronate (Hyalgan , Supartz)

They can help reduce the pain in a knee affected by osteoarthritis, increasing mobility and allowing more activity.

Normal joint fluid contains a substance called hyaluronan. It acts like a shock absorber and lubricant in your joint and is needed to help the joint work properly. Hyaluronan is highly viscous, allowing the cartilage surfaces of the bones to glide upon each other smoothly. This leads to decreased symptoms of osteoarthritis.

Currently, these drugs are only approved for treatment of mild to moderate knee arthritis.

These drugs are used to treat knee osteoarthritis pain in people who have not found significant relief of their symptoms from:

• Physical therapy
• Exercise
• Heat or cold
• Over-the-counter pain relievers

These drugs can be injected into both knees or just a single knee joint.

Potential side effects of these knee osteoarthritis injections include joint swelling and pain. They can’t be used by people with skin or joint infections. In addition, most varieties are made from processed chicken or rooster combs and should not be used in people with egg or poultry allergies. Euflexxa, however, is safe to use in people with egg allergies.

Occasionally, a severe reaction with swelling, redness, and pain, called a pseudo septic reaction, can occur with some forms of these viscosupplementation materials.

Treatment with knee osteoarthritis injections ranges from a one-time injection to weekly injections for three to five weeks. Pain relief is usually obtained by four to 12 weeks, and the effect has been shown to last for up to several months. The treatment can be repeated as necessary.

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Viscosupplementation Treatment for Knee Arthritis – OrthoInfo

Osteoarthritis of the knee is one of the leading causes of disability in the United States. It develops slowly and the pain it causes worsens over time. Although there is no cure for osteoarthritis, there are many treatment options available to help people manage pain and stay active.

In its early stages, arthritis of the knee is treated with nonsurgical methods. Your doctor may recommend a range of treatments, including:

• Modifying your activities
• Weight loss
• Pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
• Physical therapy
• Corticosteroid injections

Another treatment option is a procedure called viscosupplementation. If you have tried all other nonsurgical treatment methods and your pain continues to limit your activities, viscosupplementation may be an option.

In this procedure, a gel-like fluid called hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads. People with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints. The theory is that adding hyaluronic acid to the arthritic joint will facilitate movement and reduce pain.

The most recent research, however, has not found viscosupplementation to be effective at significantly reducing pain or improving function. Although some patients report pain relief with the procedure, some people are not helped by the injections.

Viscosupplementation was first used in Europe and Asia, and was approved by the U.S. Food and Drug Administration in 1997. Several preparations of hyaluronic acid are now commercially available.

Depending on the product used, you will receive one to five shots over several weeks.

During the procedure, if there is any swelling in your knee, your doctor may remove (aspirate) the excess fluids before injecting the hyaluronic acid. Usually, the aspiration and the injection are done using only one needle injected into the joint, Some doctors may prefer to use two separate syringes.

For the first 48 hours after the shot, you should avoid excessive activity, such as jogging or heavy lifting.

Side Effects

You may notice a local reaction, such as pain, warmth, and slight swelling immediately after the shot. These symptoms generally do not last long. You may want to apply an ice pack to help ease them.

Complications

Rarely, patients may develop a local allergy-like reaction in the knee. In these cases, the knee may become full of fluid, red, warm, and painful. If this occurs, contact your doctor immediately.

Infection and bleeding are also very rare complications of this procedure.

As is noted above, some patients will not be helped by viscosupplementation. For those who report pain relief with the procedure, it may take several weeks to notice an improvement. How long the effects last varies. Some patients report pain relieving effects for several months following the injections.

If the injections are effective they may be repeated after a period of time, usually 6 months.

Although some patients report relief of arthritis symptoms with viscosupplementation, the procedure has never been shown to reverse the arthritic process or re-grow cartilage.

The effectiveness of viscosupplementation in treating arthritis is not clear. It has been proposed that viscosupplementation is most effective if the arthritis is in its early stages (mild to moderate), but more research is needed to support this. Research in viscosupplementation and its long-term effects continues.

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Osteoarthritis of the knee: | symptoms | preparations

Osteoarthritis is one of the most common joint diseases, accompanied by the destruction of hyaline cartilage. Over time, bones, ligaments and muscles are involved in the pathological process.
Arthrosis of large joints have their own names: hip – coxarthrosis, knee – gonarthrosis.
In the absence of timely medical care, the pathology steadily progresses and becomes the cause of severe pain, a decrease in motor ability. In the absence of adequate treatment, the progression of arthrosis may lead to the need for joint replacement.

Symptoms

One of the first signs of arthrosis is pain in the knee when walking and moving. In the early stages, patients experience discomfort and temporary stiffness after rest. At first, the pain appears periodically and does not have a clear localization, but increases with physical exertion.

In the future, the symptoms become brighter, the range of motion decreases markedly.

Pain syndrome in gonarthrosis is characterized by:

• starting pains in the morning or after a long rest;
• association with physical activity – the knee hurts more when walking, standing or running for a long time. At rest, the pain subsides;
• connection with weather conditions – the pain increases with increasing humidity and atmospheric pressure, cooling;
• blockade of the joint, which is accompanied by sharp pain. Jamming occurs due to the infringement of a fragment of cartilage or bone that has separated from the cartilaginous covering or epiphysis of the bone.

Arthrosis proceeds in waves, exacerbations alternate with periods of remission. Exacerbations cause inflammation of the synovial membrane of the joint, so the nature of the pain changes to constant, aching and bursting. She worries both during movement and at rest.

Reasons

Arthrosis does not always have an obvious cause, and then one speaks of idiopathic, primary gonarthrosis. The cause of secondary arthrosis can be:

• injury – fractures, dislocations, damage to the meniscus and ligaments of the knee;
• birth defect;
• connective tissue weakness, joint hypermobility;
• autoimmune disease – rheumatoid arthritis, lupus erythematosus;
• infectious and inflammatory process – purulent arthritis, tuberculosis;
• high loads: running and intense squats are especially dangerous for the knees;
• overweight.

Arthrosis of the knee joint: treatment, preparations, injections

Conservative therapy is effective at stages 1-2 of the disease; in the later stages, surgery is unlikely to be avoided.
Acute symptoms are relieved with non-steroidal anti-inflammatory drugs – Diclofenac, Ibuprofen and their analogues tablets. If NSAIDs do not help, then corticosteroid drugs are prescribed.
Chondroprotectors are used to slow down the degradation of cartilage.
To improve blood supply and nutrition of articular structures, microcirculation improvement agents are used – Normoven, Nicotinic Acid, Cinnarizine, Pentoxifylline.
However, the best treatment for arthrosis today is injection therapy.

Intramuscularly prescribed:

• non-steroids – Flamax, Ketonal, Amelotex, Movalis, Lornoxicam, Diclofenac, Naklofen;
• hormones – Celeston, Flosteron, Diprospan, Hydrocortisone;
• vitamins – Neurorubin, Kombilipen, Milgamma, Trigamma, Compligam.

Hyaluronic acid preparations are prescribed intra-articularly, the frequency of injections and dosage is selected by the doctor based on the diagnosis. Glucocorticosteroids can be injected into the joint, but they should be prescribed with caution, since with frequent use they can worsen the condition of the cartilage tissue and aggravate the course of arthrosis.

Intra-articular injections

One of the latest developments of Czech scientists is carboxytherapy. It is based on the introduction of carbon dioxide into the joint cavity, which provokes interstitial hypoxia. The gas is supplied through a special device, causing acute oxygen starvation in the articular structures.

The result is a sharp influx of blood to the diseased area and a rapid acceleration of metabolism. Within a few minutes, the gas is removed, and the running mechanism works for a long time.
Another modern method involves the introduction of plasma into the joint – a liquid with blood cells. In this case, plasma with platelets is used, which perfectly relieves inflammation and pain, significantly slowing down the destructive process.

Physiotherapy

Comprehensive treatment of arthrosis of the knee joint includes physiotherapy. They improve local blood circulation, increase range of motion and potentiate the effect of drugs.

The doctor may prescribe:

• SWT – ultrasound – low-frequency currents contribute to the removal of osteophytes;
• magnet – the magnetic field stimulates metabolic processes, thereby accelerating tissue regeneration;
• laser – under the influence of radiation, intracellular metabolic processes are significantly improved, chemical reactions are accelerated, since the laser “works” as a conductor and enhances the effect of other methods of treatment;
• myostimulation – impulse currents restore the natural function of periarticular structures;
• electro-, phonophoresis – the introduction of painkillers or chondroprotective drugs by means of electric current or ultrasound;
• ozone therapy – oxygenation of “weak” places to activate their regeneration.

An important role in the treatment of arthrosis is played by therapeutic exercises, according to indications, massage procedures can be performed.

Operation

Surgical intervention is resorted to in advanced cases, at the 3rd stage of gonarthrosis. Most often, endoprosthesis is performed – today it is the most reliable technique.

After the operation, the body recovers in 3-6 months. Side effects and complications are rare.

There are also organ-preserving operations:

• laser and rehabilitation arthroscopy;
• plasma ablation;
• chondroplasty.

If you are prescribed intra-articular injections, or you need to repeat the course, please contact us. The center provides the service of administering drugs into the joint cavity, manipulations are carried out by experienced doctors of the highest category, so patients feel as comfortable as possible during and after the procedures.

Make an appointment by phone +375 29 628 85 82

Intra-articular injections | Artromedcenter

Healthy joints provide us with a normal level of life. When their condition begins to deteriorate, many problems arise that patients experience at home or in the course of work. There are many ailments that cause not just discomfort, but real torment – arthritis, arthrosis, etc. Getting rid of them is not so easy. However, timely treatment is required, which will exclude the development of complications

In order to effectively stop pain and swelling, it is necessary to use medications for a long time and undergo physiotherapy. To speed up recovery and rehabilitation, patients are prescribed injections of drugs directly into the joint area. This modern method of therapy demonstrates high efficiency.

Who is injectable treatment for? This method of drug administration helps to increase the rate of penetration of the drug into the area of ​​the damaged joint, into the affected tissues.

Intra-articular injections of the intra-articular type are prescribed in different situations:

• in case of pain in the area of ​​the knee, hip and shoulder joint;
• when a patient develops bursitis, synovitis or tendonitis;
• when diagnosing arthrosis or arthritis;
• if tendons, ligaments, articular cartilage are damaged.

The specificity of this technique is that it is not usually used as the main method of therapy. Such injections play the role of an effective addition to a comprehensive course of treatment, due to which pain is stopped promptly.

Another advantage of intra-articular injections is the ability to reduce the dosage of drugs taken by mouth. With this option, the number of contraindications and side effects is significantly reduced, and therefore there is no negative impact on other organs and body systems.

Application considerations

Intra-articular injections must only be administered by an experienced orthopedist to be effective. In this case, the treatment procedure will be painless and will not harm the patient. For manipulation, a syringe with an elongated needle is used, which is directed directly into the area of ​​​​the joint space. To minimize errors in the process of intra-articular injection, regular ultrasound control is used.

In some cases, fluid is drained from the joint before medication is given. This is necessary to take material for research or to eliminate possible complications. When the joint is drained, the doctor injects the medicine into the corresponding cavity.

Some patients mistakenly believe that intra-articular injections are painful. However, this is not true. Since long and thin needles are used for manipulations, the patient’s sensations do not differ from standard intramuscular injections. For uniform distribution of the drug inside the joint, it is necessary to carry out minor movements with it. In some cases, a tight bandage is recommended.

When treating a joint with intra-articular injections, it is not necessary to adhere to strict rehabilitation measures. However, it is desirable to exclude the load on the limb. This is necessary to prevent complications and increase the effectiveness of therapy. Therefore, it is important to exclude lifting loads, do not drink alcohol.

Intra-articular injections

A joint is a movable “element” with which the body can change position. In the absence of sufficient care for the articular tissue, there is the possibility of developing chronic pathologies of inflammatory etiology, which cause problems with the musculoskeletal system. In this case, an intra-articular injection – blockade may be required.

Thanks to such injections, the drug enters exactly into the affected tissue. Most often, the blockade is carried out as part of a complex treatment against the background of arthritis – a disease of the musculoskeletal system of an inflammatory nature. In addition, injections into the joint are used in the treatment of degenerative-dystrophic disorders – arthrosis.

Depending on where the inflammation is located, the blockade can be placed in the area of ​​the knee, shoulder, hip or ankle joint. In general, the manipulation practically does not differ from the usual intramuscular or intravenous injection. Medicine is injected into the joint. The duration of the procedure is approximately 5-7 minutes. To achieve the desired result, it may be necessary to make from 1 to 3 blockades. This is due to the severity of the patient’s condition.

An intra-articular injection allows:

• to quickly get rid of local pain and inflammation in the articular tissue;
• reduce the dosage of tablets taken, which makes it possible to reduce the risk of complications that may develop with systemic treatment.
• If the blockade is properly performed, intra-articular injection will be fairly harmless and will not lead to adverse reactions.

Once the patient has been accurately diagnosed, the doctor determines which medicine can be used for intra-articular injection into the joint. Usually for intra-articular injections use:

• glucocorticosteroids;
• hyaluronic acid;
• chondroprotectors;
• anesthetics or antibiotics;
• gas injections.

Only a highly qualified doctor can determine whether a blockade is appropriate.

Intra-articular injection into the knee joint

Intra-articular injections into the articular tissue of the knee are performed for trauma that is accompanied by pain. Usually, the introduction of the drug is carried out by the periarticular method or precisely into the articular cavity. Depending on how severe the disease is, the injection is performed on the outer or inner side.

When the procedure is over, the patient notices a significant reduction in pain or its complete absence. In addition, the joint becomes more mobile due to the fact that a protective film is formed on the cartilage tissue. At the end of the manipulation, friction and overload disappear in the joint.

Intra-articular injection in the shoulder joint

The most common cause of pain in the shoulder joint is a tear in the muscle tissue. In this case, pain can disturb both during exercise and at rest. When a person tries to move the shoulder, there is an increase in discomfort.

In this situation, the doctor may prescribe an intra-articular injection using glucocorticosteroids (eg, Diprospan). With the help of the pharmacological features of this group of drugs, the result is observed a couple of hours after the blockade, and the effect of the drug is noted for almost 3 weeks.

The advantage of this procedure is that it is completely painless, which eliminates the need for local anesthetics. In addition, if Diprospan is used during the blockade, complications do not develop.

Intra-articular injection in the hip joint

Intra-articular injection in the hip joint can be performed by an experienced physician. This procedure is carried out under the control of an ultrasound machine so that the needle enters exactly into the joint cavity.

In addition, the procedure requires special equipment. Such manipulation is effective in the treatment of coxarthrosis in the hip joint tissue.

Intra-articular injection into the ankle joint

Blockade of the ankle, as well as injections into other joints, allows you to deliver the drug exactly to the lesion. Thanks to some drugs, the pain syndrome is eliminated and the inflammatory process is removed, while with the help of others, cartilage is built up. But the effect of treatment in this case is achieved faster, course therapy in this case is less long.

Intra-ankle injection is performed by an experienced doctor after the disease has been accurately diagnosed. What medicine will be used to set up the blockade is also determined by the attending physician.

The accuracy of the procedure determines how effective the therapy will be, as well as the development of possible consequences. Therefore, intra-articular injections should be performed by a highly qualified specialist in a hospital setting. In addition, it should be borne in mind that such treatment of articular tissue has some limitations to its implementation. So, before proceeding with the implementation of the blockade, the patient must be comprehensively examined in order to exclude all possible contraindications.

Injectable drugs

A variety of groups of drugs are used in the process of intra-articular drug administration. Their selection is made by an experienced specialist based on the characteristics of the disease and the patient’s condition. In this case, corticosteroids, chondroprotectors, hyaluronic acid, etc. are most often used.

Corticosteroid group

These hormonal agents, which are based on corticosteroids, are prescribed to stop serious inflammatory changes. Corticosteroids in tablets have a similar effect, however, intra-articular injections provide faster penetration into the affected area and high therapeutic efficacy. At the same time, side effects on the body are minimal or absent due to the local nature of the medicines used.

In the treatment process, it is recommended to give preference to corticosteroid drugs in the form of intra-articular injections, for example, Flosteron, Diprospan, Hydrocortisone, Kenalog, Celeston. In some cases, they are used in combination with anesthetics (Lidocaine) and preparations of the vitamin group.

Intra-articular injections are effective in reducing inflammation, swelling and pain. Thanks to the use of such drugs, articular mobility increases. However, these injections cannot cure the disease itself and ensure the restoration of cartilage tissue.

The achieved effect from their application is about 2-3 months. There is another drawback of corticosteroids – they cannot be used for arthritis of an infectious origin. For such a disease, lavage of the joint and the introduction of antibiotics will be required.

Chondroprotectors

These drugs are prescribed for active degenerative processes in the joints, which accompany, for example, arthrosis. As a result of such changes, the cartilage tissue is destroyed. Chondroprotectors are able to slow down such negative changes and have a positive effect on joint recovery.

The action of drugs in this group is based on their ability to normalize metabolic processes and stimulate the production of natural collagen. It is this component that is necessary for the construction of cartilage tissue and the healing of injuries. At the same time, one should not expect an instant effect. These drugs belong to the group of long-term therapy. The method of intra-articular injection helps to speed up the action.

Alflutop is often involved in the therapeutic process – a simple but effective means for intra-articular injections from the group of chondroprotectors. With a simple course of the disease, 4-5 injections are usually enough to improve the patient’s condition. Severe diseases require a longer course of treatment.

It is important to remember that the effectiveness of chondroprotectors is manifested not only at the initial stages of the development of degenerative processes. They can also be used while running. However, in the latter case, their action will be mainly aimed not at stimulating tissue regeneration, but at preventing further destruction of cartilage structures.

Hyaluronic acid

Preparations containing this component demonstrate their effectiveness in the treatment of joint problems. Hyaluronic acid is part of the intra-articular fluid, which plays the role of lubrication in the articular structure. It provides protection against injury during movement.

Injections with hyaluronic acid increase the density and viscosity of the intra-articular fluid. Therefore, it performs its protective functions better. This component is also involved in the relief of inflammatory processes, contributes to the restoration of cartilage tissue.

Injectable acid is prescribed if articular arthrosis is diagnosed. The duration of treatment is 3-5 injections with an interval of up to 5-7 days. For the treatment of a disease in a mild form, one course of administration of the drug may be enough.

In more severe forms – with arthrosis of the second or third degree – the drug is used annually for 3-4 years. A positive feature of this therapeutic effect is the long-term effect – up to 1 year. Doctors recommend using Fermatron, Ostenil, Synocrom.

Gas injections

Carboxytherapy is a modern method used in the complex treatment of diseases of the joints and spine. It allows you to effectively stop pain. Carbon dioxide is used for injections. It is administered with the help of auxiliary equipment. Due to a sharp increase in the concentration of this gas in the articular structure or muscles after the injection procedure, the body begins to experience an artificially induced lack of oxygen. Therefore, replenishment of the deficiency is required, and blood begins to flow more actively to the affected area.

At the injection site, blood circulation increases, metabolic processes are activated. Carbon dioxide does not harm the body, as it is quickly and efficiently removed within a short period of time. The positive effect of treatment persists for a long time. When using injections with gas, side effects do not appear, because. this component is a natural result of the course of metabolism.

Use of blood plasma for injection

The PRP method uses the injection of plasma that is saturated with platelets. Intra-articular administration of this component helps to significantly activate regeneration processes in tissues, stopping inflammatory changes in them.

The peculiarity of this therapeutic approach is that human plasma is a fully compatible component. Therefore, the patient will not have an allergic reaction, and side effects will not appear. One injection requires the collection of up to 20 ml of blood. This loss is not considered significant, although doctors recommend excluding increased physical activity.

The method used involves first passing the blood through a centrifuge, as a result of which the plasma is separated. It is this element that is to be introduced into the joint area. The content of platelets in prepared 1 µl of plasma is 1 million units, although in the natural state the concentration does not exceed 200-300 thousand units. The duration of the therapeutic course is 5-7 injections with a break of 3-7 days. Subsequently, the frequency of intra-articular injections is reduced to 1 injection during the year.

Doctors say that due to the course of injections, it is possible to postpone the moment of mandatory surgical intervention.