PRP Injections, HA Injections, Cortisone
Over 4 million Canadians have arthritis and the number is growing. Many individuals have or will develop osteoarthritis, which will affect their health and quality of life. Our previous posts have highlighted some of the ways OA pain and limitations can be handled. For many people exercise, weight management and oral or topical medications help a lot. Getting stronger is such a good thing! However for those who do not find relief with these treatments alone, knee injections for arthritis may be more helpful. With three products to choose from, and when used in combination with other treatments, these injections can help make exercise and activities easier.
Keys to effectively managing osteoarthritis:
Diet and Nutrition can help your Osteoarthritis – What foods are good for arthritis.
Osteoarthritis Management with Rest, Recovery, and Sleep – Who to see, what to do, and how to manage your arthritis.
Bracing and Aids for Osteoarthritis
Knee Injections for Osteoarthritis
Knee Injections for Arthritis
Cortisone Knee Injection
Corticosteroids, commonly known as “cortisone shots,” these drugs are effective at reducing inflammation in a swollen arthritic knee. For decades they have been used to help with the pain of osteoarthritis. The drug is affordable and covered by most drug plans. A limitation of cortisone injections is that the benefits of reduced pain and swelling do not last. Researchers suggest they help for only about 2 months. More recently it has been shown that too many injections in a 2 year period may actually reduce the thickness of the cartilage in the knee- the exact tissue that wears down in OA. The medical community think it’s the change in amount and quality of the cartilage that speeds up other changes seen in OA. While still helpful for some patients, cortisone knee injections may not be the long term solution they once were thought to be.
Viscosupplementation – Hyaluronic Acid Injections
What is a gel injection for knees? The gel is actually hyaluronic acid, and is a natural component of joint fluid found within the knee that helps cushion the joint. It is produced from cartilage cells and helps improve the joint environment. When knees develop osteoarthritis, the naturally occurring hyaluronic acid is defective and works less well. Viscosupplementation, or gel injections for knees, act to replace and restore the normal joint fluid when injected into an arthritic joint. Most HA gels are synthetic, made in such a way to help cartilage cells function more normally. Not all gels are the same and at LiveActive we use a HA gel that has been shown to benefit people with mild to moderate Osteoarthritis.
The gel injection results in a gradual decrease in pain and swelling. Patients also notice improved mobility that lasts on average 6 months.
There appear to be no long term side effects to HA injections. In fact, people who have hyaluronic acid injections repeated over several years delay needing a total knee replacement. Viscosupplementation gels are paid for by most extended health plans.
Platelet Rich Plasma (PRP)
PRP injections have been in the news when celebrity athletes talk about how it has helped them recover from injury. PRP is still relatively new technique that involves taking the platelets collected from a sample of a person’s blood, and injecting them into the arthritic knee.
1. Draw Blood from Patient 2. Place Blood in a Centrifuge to Spin 3. Extract PRP 4. Inject PRP into Desired Location
It is a natural, regenerative health treatment. Platelets are rich in growth hormones and other molecules that can reduce inflammation but also stimulate cells in the knee once injected. Studies have shown that there is less cartilage loss up to a year after PRP treatment, and that may be a sign that the OA is slowing down.
PRP injections have been shown to decrease pain and swelling, and improve function in patients who have had the treatment. These improvements also occur after about 4 weeks, and improvements last about 1 year. There are no serious side effects with platelet rich plasma injections. While the best way to prepare PRP is still being studied, many people find it a helpful and convenient treatment for their OA pain. At this time, PRP injections are not covered by government or extended health plans. A little more expensive than viscosupplementation, its longer lasting benefit makes this an appealing option for many.
For more information on the PRP offered at LiveActive: https://www.regenlab.com/
Ultrasound Guided Injections
Once you’ve determined which knee injections for arthritis are right for you, the next challenge is the procedure. Many sport medicine doctors who administer knee injections are comfortable injecting the knee without the use of imaging. However, research shows that accuracy increases to almost 100% when an injection is performed under ultrasound guidance. In the past, ultrasound was only available in hospital X-ray departments, but is now commonly used in community clinics. An ultrasound will provide an image of the joint space and the needle, which will ensure the injection is provided in the most effective location. The use of this specialized technique is not covered by OHIP, extended health benefits, but is included in the cost of PRP injections.
Any knee injection for arthritis can result in a few days of increased discomfort and stiffness, but for many the long term gains are worthwhile. Speak to your Family or Sport Medicine Doctor to discuss if joint injections may be helpful for you.