Living with knee pain can be a challenging and limiting experience, affecting not just mobility but overall quality of life. For many individuals dealing with conditions like osteoarthritis or joint degeneration, finding effective and lasting relief can be a primary concern. In recent years, a promising solution has emerged in the form of knee gel injections, also known as viscosupplementation.
These knee gel injections offer a non-surgical approach to reduce pain and improve knee function, providing hope for those seeking alternatives to traditional treatments. Let’s delve deeper into what these injections entail and how they can offer a reprieve for those grappling with persistent knee discomfort.
This process is usually accomplished in a doctor’s office and conducted by an orthopaedic physician. Some rheumatologists and primary care doctors may also offer this treatment. The injection procedure takes a few minutes and usually involves no prior preparation. However, discussing the medical history and current medications with the doctor before this treatment is advisable.
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Types of Injections for Knee Pain
Cortisone Injections
Generally, Cortisone injections are advised for patients with knee arthritis when they are dealing with pain and swelling. They can be handy for knee pain and osteoarthritis symptoms. The infusion can quickly reduce these symptoms, usually within 1-3 days. Symptom progress and advancements in VAS (visual analog scores), which measure pain numbers on a scale of 1-10, typically improve greatly within the first six weeks after these injections but may manage to decline around the 12-week mark post-injection.
If symptoms recur, these injections can be given repeatedly every 3 to 4 months. Nevertheless, waiting until pain/swelling symptoms have returned is suggested. Prophylactic injections and more regular administration of the cortisone injections tend to lead to their becoming less adequate over time and won’t end up working as well.
Knee Gel Injections
These injections are typically suggested as an option to cortisone injections and can be given every six months or so. Medicare protects them every six months, and insurance companies cover them at various intervals. These are generally not shown on the exact day as cortisone injections but can be spaced out a few weeks afterward to help prolong the effects.
What type of knee injection should I choose?
The cortisone injections are most effective for patients with severe pain and acute swelling, as they provide fast relief. The gel injections take effect slowly and can take 4-6 weeks to have their full effect. Therefore, it’s recommended to offer them when the patient suffers more from dull, achy pain and not acute swelling. We often give a cortisone injection to decrease pain and swelling in those settings.
If the symptoms persist even after 2-4 weeks of dull, achy pain, a gel injection may be given to extend the relief. Studies have shown that these injections can decrease VAS scores, with improvement starting 4-6 weeks after injection and lasting for up to 6 months.
Knee Injections Side Effects
Both types of injections have minimal side effects. Patients may experience soreness and pain at the injection site, which should go away within 24-48 hours. Patients who have diabetes may experience a temporary increase in blood sugar levels for 48-72 hours following cortisone injections. Any injection has a small (<1%) risk of infection. With gel injections, there is a reported 5% risk of a “pseudo-sepsis” reaction where they can develop a red, hot, swollen knee that mimics infection.
This typically improves with ice and NSAIDs after infection is ruled out. Long-term use of cortisone can damage healthy cartilage, but for most patients, we recommend cortisone injections for already damaged cartilage arthritis.
The good news is that patients can almost always expect relief from at least one of these injections. The real question will be which works best for them and how long the effects last.
Cortisone injections tend to work quickly and provide relief, but this can be as short as a few weeks or as long as several months. The gel injections are effective for about 50% of patients, but for those that it works well, those patients tend to see improvement in VAS scores for at least 4-6 months.
What if Knee Injections Don’t Work?
Knee replacement would be the last step in treating a patient with knee arthritis. However, this should only come after the patient has tried and failed with injections, bracing, NSAIDs, using a cane/walker, and, most importantly, a formal physical therapy program to maximize strength, motion, and weight loss, if necessary. When these treatments don’t work or stop working, then the patient’s options are to live with their current symptoms or to proceed with knee replacement.
Knee replacement is the only thing that changes what the X-ray looks like and truly gets rid of the arthritis. All of the other treatments control the symptoms. The knee replacement is an open surgery where the ends of the femur and tibia, where the damaged cartilage is, are removed, and metal caps are placed on the ends of the bone with a polyethylene spacer in between. This becomes the new knee joint.
Patients nowadays typically go home the same day and walk, with assistance, on the day of surgery. Physical therapy ensues, and patients usually recover in about three months. Knee replacement is a beneficial operation in the right candidate with typically 85-90% excellent outcomes.
Final Words
While knee gel injections present a non-surgical option with minimal side effects, consulting with a healthcare professional remains crucial to determine their suitability and to explore comprehensive treatment strategies. Overall, knee gel injections are a viable adjunctive therapy, offering hope and improved quality of life for those with knee osteoarthritis.
