Gel/steroid joint injections

1-CorticoSteroids or Steroid Injections

Cortisone injections are sometimes called “corticosteroids” or just “steroid injections”. The injections are made up of the medication “cortisone”. Cortisone is injected right into the troubled joint area and is used to treat inflammation.

The Procedure: Cortisone injections are painful when applied, so the area is numbed with local anesthetic. The local anesthetic will temporarily take away all feeling from your joint area. Once the area is numbed, the cortisone is administered. For those getting an injection in their hip, an ultrasound or x-ray is used to guide the physician to the exact spot.

Timeline: The numbing medicine can last up to 24 hours. It can take several days for the steroid injection to take noticeable effect. The average success for cortisone injections range from patients feeling little relief to experiencing 6+ months of relief. Effective up to 1 year. Can be repeated 3-4 times a year.

Cost: Covered in full or partially by most insurance companies.

Pros

• More powerful than oral anti-inflammatory medications.
• Can offer relief of 6 or more months in some patients.
• Can postpone the need of joint replacement surgery.
• Suppresses immune system (beneficial for controlling rheumatoid arthritis where the immune system mistakenly attacks its own tissues).

Cons

• Repeated use can cause bone loss/thinning, weakening of tendons, nerve damage, and cartilage loss (this is why it’s not recommended more than 3-4 times a year).
• Risk of Infection (low).
• Risk of allergic reaction (low).
• Can cause blood sugar levels to rise (problem for diabetics).
• Exposure to high levels of cortisol over an extended period can increase the risk of hypercortisolism (Cushing’s syndrome). Cushing’s syndrome comes with a host of long-lasting or permanent side effects.

2- Viscosupplementation Injections
(also known as Hyaluronic/ Hyaluronan injections, Gel Injections, Rooster Comb injections, Intra-Articular Injection and Joint-Fluid Therapy)

With this injection type, a gel-like fluid (called hyaluronic acid) is injected right into the joint. Hyaluronic acid is a naturally occurring substance found in the fluid that surrounds the joint. People with osteoarthritis have less than normal hyaluronic acid in their joints. Adding hyaluronic acid (which is usually in its water-soluble form, sodium hyaluronate) to a troubled joint helps with movement and pain, absorbing the impact placed on your joint.

Lubricating your joint is like greasing up a rusty bike chain!

Majority of hyaluronic injections actually contain processed chicken or rooster combs (hence the name “rooster injections”). People with allergies to poultry, eggs and feathers may need to avoid this type of injection!

The Procedure: Depending on the brand and product your physician uses, in a single injection episode anywhere between 1 and 5 shots will be administered. Before injecting into the knee, the excess fluid will first be drained. Once excess fluid is drained the knee or hip is injected. For a hip joint, the injection is administered with the aid of an x-ray or ultrasound for accuracy.

Timeline: The injection can take several weeks to take full effect. Effective up to 6 months. Can be repeated 2-3 times a year.

Cost: Covered in full or partially by most insurance companies.

Pros

• Hyaluronic acid can offer relief for 6 or more months in some patients.
• Draining of fluids from joints (done in the procedure) can also offer pain relief and reduce swelling.
• Can postpone the need of joint replacement surgery.

Cons

• Risk of Infection (low).
• Can cause a local reaction which includes temporary pain, warmth, slight swelling, redness, fluid retention in joint, muscle pain etc.
• Feelings of nausea and headache.
• Mixed reviews and research about whether or not it really helps.

3- Platelet Rich Plasma (PRP) Injections
Platelet Rich Plasma (PRP) is relatively new to orthopedics but has been used during surgery for cell regeneration for the last 20+ years. PRP is derived from your immune system’s platelets which are found in blood. The platelets are then concentrated and can be injected into the troubled joint area.

PRP injection therapy is said to stimulate healing by producing more collagen. The formation of collagen occurs naturally in skin, bones and tissue. Building collagen in a troubled joint means adding support and even correcting underlying issues caused by arthritis, dysplasia and diseased bone and cartilage. This can reduce pain and improve function.

Timeline: Lasts 3-4 months and can be repeated 1-2 times a year. Cost: Not covered by insurance. $500+.

Pros

• PRP injections are safe with few risks or side effects since the injection substance is naturally occurring in your body.
• Some studies show that PRP is most effective in combating joint pain–even more so than cortisone or viscosupplementation. AAOS published a study in April 2017 where a controlled patient group that had PRP therapy “showed a 90 percent decrease in pain from baseline. Patients in the steroid group showed an 8 percent increase in pain from baseline.”

Cons

• Risk of infection (low).
• Risk of local reactions like tissue damage and nerve damage (low).
• It’s hard for experts to judge the effectiveness of PRP in joint replacement candidates.
• Effectiveness is based on overall health of patient.
• Long-term effects are unknown since it has not been tested or researched over a long-period for treating osteoarthritis.
• Standard guidelines of treatment for osteoarthritis have not been established.
• Expensive and not covered by insurance.

4- Stem cells injections:

Stem cells are like a “magic cell” that can turn into other cells and help heal a damaged area. Stem cells are anti-inflammatory and regenerative, therefore the idea is that when injected into a joint with arthritis (which is inflamed and degenerative), it can heal the area.

Stem cells are found throughout your body and are extracted from a part of your body that has a high-volume of cells–generally bone marrow, fat tissue, or circulating blood. For the procedure, your own stem cells are extracted and reinjected into the damaged area. Unlike cortisone hip or knee injections or hyaluronic injections, stem cell injections have not been approved by the FDA to treat arthritis.

Timeline: A single stem cell injection episode is 2 sessions (1 to extract and re-inject stem cells and a second for a platelet injection (similar to PCP). Lasts 3-4 months and can be repeated 1-2 times a year. Cost: Not covered by insurance. $1000+.

Pro

• Studies point to stem cell therapy helping the body grow new tissue.
• Helps reverse effects of arthritis by rebuilding damaged tissue and counteracting bone degradation.

Cons

• Extracting bone marrow can be very painful.
• Risk of infection (low).
• Risk of local reactions like tissue damage and nerve damage (low).
• It’s hard for experts to judge the effectiveness of stem cell injections.
• Long-term effects are unknown since it has not been tested or researched over a long-period.
• The most expensive injection type.