Joint Injections

About Joint Injections

Joint injections, also known as “intra-articular” injections, can be used to alleviate the symptoms of arthritis.

They are generally more effective for knee arthritis compared to hip arthritis. While injections cannot regenerate cartilage, they can improve symptoms.

Mr. Costin-Brown utilises two different types of injections in the management of knee osteoarthritis:

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Steroid injection

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Viscosupplementation

Procedure

The procedure for both types of injections is the same. It is performed under sterile conditions to minimize the risk of infection. The skin around the knee is prepared with an antiseptic solution. A needle is then inserted into the joint, and the solution is injected directly into the knee before the needle is withdrawn. Finally, a sterile dressing is applied.

The majority of patients tolerate the procedure well. Although the needle insertion can be unpleasant, similar to undergoing a blood test, the procedure usually takes less than 1 minute, and the pain at the injection site often subsides immediately.

Steroid Injections

Steroids are strong anti-inflammatories, and when injected into the joint they act to reduce inflammation and relieve pain. As they are injected directly into the joint, their effects are localised within the joint itself.

The effect of the steroid in the joint diminishes over time, and the duration of response varies widely among patients. On average, steroid injections provide 2-10 weeks of symptom improvement. Some patients may experience limited benefits, while others may have longer-lasting effects. Repeated injections often yield diminishing returns and do not tend to last as long as the initial one. Therefore, Mr. Costin-Brown does not recommend repeated steroid injections for long-term management of knee arthritis.

Whilst the steroid is working and giving symptom improvement, it is important to maximise non-operative efforts (including physiotherapy, weight loss, etc…) to improve your knee health which will hopefully improve your symptoms when the steroid does inevitably wear off.

Viscosupplementation

The normal joint fluid in the knee contains hyaluronic acid, which functions as a lubricant and shock absorber. As arthritis develops, the function of hyaluronic acid diminishes, contributing to the progression of arthritis.

Viscosupplement injections contain hyaluronic acid and aim to restore the biomechanical and biochemical functions of normal joint fluid. There are various types of viscosupplement injections, and Mr. Costin-Brown utilizes one called “SynviscOne,” which contains a type of hyaluronic acid that is believed to remain in the joint for a longer duration compared to other formulations.

The widespread use of viscosupplements in the management of knee osteoarthritis has limited supporting evidence and is not offered on the NHS. However, some smaller research studies do support their use. In one study, 64% of patients reported pain relief compared to baseline at 26 weeks following the injection.

Viscosupplement injections are generally considered safe. The most commonly reported complications include joint pain, pain at the injection site, and joint swelling. Other risks include infection, bleeding or bruising, allergic reactions, and failure to improve symptoms.

For more information about Synvisc One, you can visit their website at: https://www.synviscone.com