In the spectrum of treatments for osteoarthritis pain, injections made directly into the affected joint often prove to be the “Goldilocks choice” – not too much, not too little, just the right treatment. Injections aren’t as complicated
as surgery, but can offer relief for many who find oral medication isn’t enough.
The shot, a short-term solution to a chronic problem, delivers medicine right into your joint. It takes a few minutes and is done in your doctor’s office.
Shots have proven beneficial to many osteoarthritis sufferers. But for some patients, injections provide little, if any, relief. Two types of injections are used routinely.
Corticosteroid or Steroid Injections
Corticosteroids are medications that mimic the effects of the hormone cortisol, which is produced naturally by the adrenal glands. The purpose of the injection is to reduce the irritation caused by bone interacting directly with bone, the result of the
smooth, cartilage interface that protected joint surfaces wearing away.
Corticosteroid or steroid injections, directed into the knee, hip, or other joint, may quickly ease swelling and pain. The benefits can last anywhere from a few days to a few months. Some patients, however, experience no change.
Dr. Michael Raab explains the use of injections to treat joint pain.
Patients often have questions regarding injections into a joint. And we’ll take the knee as an example. If we’ve already treated a patient with conservative measures such as anti-inflammatories, exercise, therapy, perhaps a brace, and the patient still has pain, we will typically offer an injection into the knee. Initially, we will offer an injection which is a combination of a steroid as well as a local anesthetic. Typically Depo-Medrol, Marcaine, and Lidocaine which is a steroid preparation and two types of anesthetics, one short-acting, one longer-acting. And this can give the patient either short amount of relief or a long-term amount of relief depending on how they respond. The goal of the cortisone injection is to interrupt the inflammatory cycle that’s within the knee creating the pain and swelling and discomfort. Every patient is different. Some people may have great relief with cortisone injection, some people may have very little relief. It really varies by the patient. Patients often ask how many can I have. And typically, we try to space them out at least two to three months apart. But once you’ve had three, four, or five injections in a particular joint and you still have pain, it’s probably not a great idea to continue doing what’s not helping. On the other hand, if you have great relief that lasts you for six to nine months from a cortisone injection, it would make sense to simply continue that approach until it’s no longer effective. The other type of injection that we often offer the patient is some of the newer gel injections, which is a high molecular weight gel that is a clear thick fluid that we can inject again into the knee to help cushion and smooth up the rough edges within the knee. It does not create new cartilage, it does not create a new joint, it simply smooths out and evens out and perhaps creates a bit of a thick cushion between the two worn out parts of the knee. So, those are some of the common injections that we will offer. The other patients – or other questions that the patients may ask is, “Will I gain weight?” And some people report that, many do not. It’s hard to say whether that truly leads to that or not. It’s more seen with oral steroids taking by mouth that can lead to weight gain. Typically an injection in a joint does not lead to prolonged weight gain.
Many find that these injections lack many of the side effects of oral corticosteroid medications. But steroid injections do have risks. Repeated knee injections may contribute to cartilage breakdown. For that reason, your health care provider will likely
limit the number of injections you can receive in any one joint.
The shot, a short-term solution to a chronic problem, delivers medicine right into your joint.
Dr. Matthew Lawless explains that corticosteroid injections can be repeatedly administered, so long as each shot brings several months of pain relief.
Is there a limit on how many joint injections to have?
Patients often ask me if there is a limit to how many corticosteroid injections they can have into their knee. Typically steroid injections are used any for three months or so as indicated and the indication would be the amount of pain relief they get. Once the injections get to be less than three months then we’ll usually be more aggressive with either Hyaluronic acid injections or to consider surgical therapy. The amount of injections patients receive in their knee can be highly variable as long as they’re effective and lasting several months then I will continue giving them indefinitely.
Injections are used for pain relief. There’s a debate whether the injections will cause further damage to the knee joint. My opinion is that the steroids are helping people increase their function. There is already disease in the joint and they do not cause further damage.
Hyaluronic Acid Injections
These injections, also known as viscosupplements, are only for osteoarthritis in the knees.
When your joint was healthy, a thick substance called synovial fluid provided lubrication so your bones could glide against one another. An injection of gel-like hyaluronic acid (one of the substances in synovial fluid) may help your knee joint work more
smoothly again.
Some enjoy pain relief and better movement after the shot, but others are not helped at all. Some research shows viscosupplementation has not been effective at significantly reducing pain or improving function.
Depending on the product used, you’ll get one to five shots over several weeks.
If there’s any swelling in your knee, your doctor will remove (aspirate) excess fluids before injecting the hyaluronic acid. Usually (but not always), the aspiration and the injection are done using only one needle injected into the joint.
Sources: Michael Raab, MD, Premier Orthopedics; Matthew Lawless, MD, Premier Orthopedics; Arthritis Foundation; American Academy of Orthopedic Surgeons (AAOS)
