Injections for Arthritis

Cortisone Shots and Viscosupplementation Treatment are two non-surgical treatment methods that have proven to relieve pain and restore function to the knee. Dr. Gordon offers both these treatment methods as therapeutic options.

Cortisone Shots

The information below is for our patients who have received an injection in our office. Medications used in your injection included:

  • Marcaine (a long anesthetic)
  • Lidocaine (a shorter acting anesthetic)
  • Depo-Medrol (a long acting form of cortisone)

The injection you have just received normally goes without incident. The injection area may be sore, throbbing or slightly swollen for one to two days. Unless your doctor tells you otherwise, applying ice to the area (10 to 15 minutes every one to two hours) for the first day or two will help decrease the pain.

Usually a numbing medication is given with the injection, which can last for five to 12 hours. The actual Cortisone may take up to two to five days to take effect. If you develop any abnormal symptoms, such as itching, swelling, redness, rash, or shortness of breath, please call our office. Normally, these are temporary symptoms that resolve within a day but we are more than happy to answer any questions you may have.

Diabetic Warning

If you are diabetic and using insulin, this injection may elevate your blood sugar for the next one to five days. Please monitor your sugars closely and if they fail to return to acceptable levels, please contact your primary care physician.

The doctor would like you to observe the area of the injection for redness, swelling, or increased heat. If any or all of the reactions occur, please call our office as soon as possible. This reaction may indicate the first signs of infection. This is a very rare event, but best if caught early.

The duration of pain relief from these injections varies widely between patients. Some report two or more months of relief while other patients report only a few weeks of relief.

Thank you and please follow your doctor’s directions. Call us with any questions or problems.

Viscosupplementation Treatment for Arthritis

Adapted from the American Academy of Orthopaedic Surgeons

Although there is no cure for osteoarthritis of the knee, there are many treatment options available. The primary goals of treatment are to relieve pain and restore function.

In its early stages, arthritis of the knee is treated with nonsurgical methods. Some of the more common options include changes in activity level, pain relievers such as ibuprofen or nonsteroidal anti-inflammatory drugs (NSAIDs), along with physical therapy, and corticosteroid injections.

Another treatment option is a procedure called viscosupplementation. In this procedure, a thick fluid called hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial (joint) fluid. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads.

People with osteoarthritis (“wear-and-tear” arthritis) have a lower-than-normal concentration of hyaluronic acid in their joints. Viscosupplementation may be a therapeutic option for individuals with osteoarthritis of the knee.

Effects of Viscosupplementation

Viscosupplementation has been shown to relieve pain in many patients who have not responded to other nonsurgical methods. The technique was first used in Europe and Asia, and was approved by the U.S. Food and Drug Administration in 1997. Several preparations of hyaluronic acid are now commercially available.

Immediate Effects

Hyaluronic acid does not have an immediate pain-relieving effect.

For the first 48 hours after the shot, you should avoid excessive weight bearing on the leg, such as standing for long periods, jogging or heavy lifting.

You may notice a local reaction, such as pain, warmth, and slight swelling immediately after the shot. These symptoms generally do not last long. You may want to apply an ice pack to help ease them.

Rarely, patients may develop a local allergy-like reaction in the knee. In these cases, the knee may become full of fluid, red, warm, and painful. If this occurs, contact your doctor immediately.

Infection and bleeding are also very rare complications of this procedure.

Longer Term Effects

Over the course of the injections, you may notice that you have less pain in your knee.

Hyaluronic acid does seem to have anti-inflammatory and pain-relieving properties. The injections may also stimulate the body to produce more of its own hyaluronic acid.

Effects may last for several months.

Viscosupplementation may be effective in relieving the symptoms of arthritis, but has never been shown to reverse the arthritic process or re-grow cartilage.

Procedure

During the procedure, if there is any swelling in your knee, your doctor will remove (aspirate) the excess fluids before injecting the hyaluronic acid. Usually, this can be done at the same time, with only one needle injected into the joint, although some doctors may prefer to use two separate syringes. Depending on the product used, you will receive one to five shots over several weeks.

Outcome

Viscosupplementation can be helpful for people whose arthritis has not responded to basic treatments. It is most effective if the arthritis is in its early stages (mild to moderate). Some patients may feel pain at the injection site, and occasionally the injections result in increased swelling. It may take several weeks to notice an improvement after viscosupplementation. Not all patients will have relief of pain.

  • If the injections are effective they may be repeated after a period of time, usually 6 months.
  • The long-term effectiveness of viscosupplementation is not yet known and research continues in this area.
  • If your arthritis is not responding well or if you are trying to delay surgery, you may wish to discuss this option with your orthopaedic surgeon.