Do Injections work for osteoarthritis pain in the hip and knee?

Posted on: February 20th, 2015 by Dr. Frank Bohnenkamp

So you’re thinking about an injection to treat your hip/knee osteoarthritis. Here’s what you should know.

First, if your knee pain or hip pain is keeping you from pursuing the lifestyle you want, then you need to do something about it. Live the lifestyle you want. Go climb mountains or ride your bike, or shoot a basketball. Now, let’s look at one option that could get you closer to pursuing a more active, pain-free lifestyle.

I think the most important thing to say right off the bat is that cortisone injections or viscosupplementation “gel shot” injections are not cure-alls. They work in tandem with activity modification, weight loss, physical therapy, and anti-inflammatory medications.

[quote]”Cortisone shots are inexpensive and can provide long lasting relief.”[/quote]

On top of that, injections function as the first line of conservative treatment to alleviate your symptoms, but what you should also know about these injections is that they can help.

One advantage of corticosteroid and hyaluronic acid viscosupplementation injections basically buy you time. They provide pain relief and help to stave off joint replacement, which can be quite helpful as it gives patients the opportunity to think about what exactly they want, and they can make those decisions with less pain because of the injections they’ve received.

Let’s look at some of the concerns patients have about these injections.

Many patients want to know if the injections work, how long they last, and how their daily activities and work may be affected.

I like to tell my patients corticosteroids are like hydrocortisone you put on a rash. The first couple days you don’t notice much difference but after a couple days the inflammation and itching decrease.

They work the same in the joint.

The medicine decreases the inflammation of the synovium around the joint, and in a couple days it starts to decrease the pain, swelling and inflammation.

[quote]”Patient’s can usually resume their normal activities in a day or two with minimal if any restrictions.”[/quote]

Cortisone shots are inexpensive and can provide long lasting relief. Unfortunately, It is difficult to predict how long the injection will last. On the plus side, scientific studies show benefits to cortisone injections and significant improvement even if for a short duration when compared to placeboes.

Concerning how long the injections last, I like to say is if you have mild arthritis, I expect the shot to last 1-3 months or longer–sometimes up to a year. If you have severe arthritis, it may only last a week or two or even less, but sometimes it can last a longer.

I wish I could say it’s an exact science, but it’s not. This is the part where we insert “Individual results may vary.”

I repeat my injections in the knee every 3 months, but it’s important to note I only repeat them if they continue to work. I think we can agree no one should go through (or pay for) treatment that doesn’t work.

After injections stop working, it’s time to consider a joint replacement. If you’re not sure if you’re ready, check out this post by Dr. Barba, one of my colleagues.

4 Common Questions about Injections Answered:

What are the risks with repeat cortisone injections?

  • There is really little risk with a cortisone shot. Sometimes patient’s can get a local pain or swelling in the area of the injection or in the joint as a reaction to the injection, but this is usually inconsequential and should resolve quickly.
  • The incidence of infection is extremely low.
  • Patients with diabetes may see a slight elevation in blood sugar.
  • Patient’s can usually resume their normal activities in a day or two with minimal if any restrictions.

Do repeat cortisone injections make the joint worse?

This is a misnomer. Unfortunately no type of injection will reverse the worsening or progression of osteoarthritis. They help alleviate symptoms but will not make the joint worse off.

Do hyaluronic acid (HA) injections work?

  • This is called viscosupplementation. It is a derivation of hyaluronic acid which is a natural occurring substance within normal cartilage. It helps lubricate the joint surface and helps with load compression across the joint.
  • Many different forms exist but they are geared to provide a lubricating surface to the arthritic knee in hopes to get better motion and decrease pain over time by preventing bone rubbing on bone.
  • They also do not reverse arthritis progression. They tend not to alleviate pain immediately like cortisone but can take weeks.
  • They can usually be repeated in 6 months if the patient demonstrates symptom improvement.
  • Some outcome measures show increased durability of symptom relief at 5-13 weeks with HA injection compared to CSI. However, there was no difference at 1 year between the two.

Do platelet rich plasma injections work?

Some patient’s are asking for these injections as they become more known and popular. Platelets have significant numbers of potential healing factors and anti-inflammatory potential. There is some evidence in scientific literature that these injections have demonstrated up to 6 months of relief in younger patients with only mild evidence of arthritis, but no benefit was seen for older patients with moderate to severe arthritis when compared with viscosupplementation.

More research is needed in this area, because these injections tend to be expensive.

All of these injections can help. It’s just a matter of how long they will help. I hope for quite awhile! After they stop helping, it’s time to consider joint replacement if you see these 7 signs in your life.

If you have any questions, please call my office for more information.


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