Arthritis occurs when the cartilage of the joint wears away, exposing bone. This bone exposure leads to pain, swelling, and reduced function. Generally, simple treatments such as exercise, medications, and weight loss have the best effect on arthritis. However, we use knee injections for arthritis in London to help these simple treatments in complex cases. So, what are the options for knee shots for arthritis, and how do you decide?
Knee shots for arthritis: What is available?
We can use cortisone, hyaluronic acid, or platelet-rich plasma.
Cortisone injections for arthritis
Cortisone is the most commonly used injection. It is a potent anti-inflammatory drug that reduces inflammation, swelling, and pain.
Overall, studies show short-term improvement in knee pain after a cortisone injection. Generally, the cortisone effect is better in milder knee arthritis cases and lasts up to 3 months. However, there is no difference between cortisone injections and placebo at six months for knee arthritis.
Moreover, there are some concerns about cortisone injections for knee arthritis. For example, a recent study shows you are twice as likely to have cartilage damage after a cortisone injection compared to other injections. In addition, there is worrying evidence that having a cortisone injection could increase your risk of needing a joint replacement earlier. If you plan on having a knee replacement, studies suggest avoiding having a cortisone injeciton for up to 3 months before surgery.
Gel injections for arthritis
We also use hyaluronic acid (Ostenil, Durolane, Synvisc) to treat osteoarthritis.
Hyaluronic acid is a natural substance found in bones, joints, and tendons. Injecting hyaluronic acid into a knee joint lubricates and reduces inflammation.
Overall, studies show a moderate effect on pain of osteoarthritis that can last for up to 6-12 months. However, a type of hyaluronic acid with a high molecular weight and cross-link is more effective for knee arthritis. A recent study found that a high molecular weight cross-linked hyaluronic acid has a more significant pain-relieving effect than most other injections or medications. Specific brands that are high molecular weight include Durolane and Synvisc-1. In addition, there are very few side effects apart from occasional reactions. All in all, hyaluronic acid is a good option for mild to moderate knee arthritis.
PRP injection for arthritis
Platelet-rich plasma (PRP) is becoming more popular for treating arthritis and tendonitis.
We obtain PRP from whole blood. Then, we spin the blood to separate the plasma from red and white cells. Plasma contains a high concentration of platelets that are rich in growth factors. Finally, the plasma is injected into joints.
Overall, 23 studies show a positive effect of PRP on knee osteoarthritis. Furthermore, comparing PRP to other injections, such as hyaluronic acid, reveals a slightly better effect of PRP, although more than one injection of PRP is required.
Arthrosamid injeciton for knee arthritis
Arthrosamid is a unique hydrogel of water molecules attached to a polyacrylamide backbone. The injectable is non-degradable, meaning the body does not break it down.
It works by coating the lining of the synovium of the knee joint, reducing inflammation, and providing lubrication.
Recent studies show improvement in pain scores lasting for up to 2 years. Compared to hyaluronic acid, it works better in younger and slimmer patients.
Comparing injectables, Durolane, PRP or Arthrosamid: Which knee shot for arthritis is more effective?
According to studies published on each injectable for knee arthritis, we think the effectiveness for the treatment of knee arthritis in percentage terms is as follows:
Durolane: 65-70%
PRP: 60-80%
Arthrosamid: 80% (although long-term data for Arthrosamid is lacking as it’s a relatively new drug).
Stem cell injections for arthritis in knees
Stem cell therapy is becoming more popular as an injection in arthritis. These stem cells can change to other cells and regenerate new tissue.
Stem cells are usually derived from various sources, including fat, bone marrow, and fetal tissue. However, the process of taking and processing these cells can be difficult and expensive. So, are the hassle and cost worth it?
Generally, the answer is no. While some smaller low-level studies show promise, higher-level studies show no difference between stem cells and cheap sterile water. A recent study comparing stem cells to cortisone injections found no difference between groups at a year.
So, overall, we recommend that you don’t waste your money (up to £7000) on stem cells until further evidence of their effectiveness becomes available.
Other frequently asked questions about knee shots for arthritis:
What is the best injection for knee arthritis?
It depends on the patient. If you have severe acute pain and swelling, cortisone is a reasonable choice.
However, in longstanding low-level pain, other injectables with longer-lasting effects, such as hyaluronic acid, PRP or Arthrosamid.
According to studies published on each injectable for knee arthritis, the effectiveness of knee shots for arthritis in percentage terms is as follows:
Durolane injection: 65-70%
PRP injection: 60-70%
Arthrosamid injection: 73%. However, younger patients (less than 70 years) have 80-95% improvement.
Should you use ultrasound to guide knee injections?
Yes. Ultrasound-guided knee injections are more accurate and effective than landmark-guided injections. A recent review found that ultrasound-guided was much more accurate than blind injections.
Final word from Sportdoctorlondon about knee injection for arthritis in London
We use intra-articular injections for arthritis when other simple treatments like exercise and weight loss are not good enough. Gene ally, use cortisone for a sore, swollen knee. Hyaluronic acid or Platelet-rich plasma is our preferred long-term choice. Finally, you should always perform injections with ultrasound to make it more accurate. If you’re thinking about an injection, you should do your homework and find a doctor with experience in ultrasound and injections.
Thank you! Excellent article. Appreciate the great diagrams and 3 D models. I will try exercise.
Thanks for your comments.
Great read!!! Thanks for sharing such a great read, keep sharing such a great blog.
Explained to the t , thank you for the info. Awesome articule full of info
Excellent information, Thank u
I I have heard of injection for arthritis in knees to help build the the cartilage without have having knee operation if there is please if could let me have more details and how long it last and how much it cost I’m in Leeds I am 66 years
Thanks
Hi Zahoora,
Unfortunately, we do not have an injection that builds cartilage – even stem cell injections do not re-build cartilage.
LM
Is it true that for PRP to work, it is essential to have at least some cartilage left in the joint, and that it won’t work on bone-on-bone situations?
Hi Gina, Many thanks for your question. In general, PRP or any injectable for knee arthritis works better for milder cases. So more severe cases – bone on bone- means PRP works less well.
Hello, I am having increased knuckle and finger swelling, worse on the left, could I get some type of injection and still be able to not take time off from work ? Thank you
Hi Alison,
if your finger swelling is due to osteoarthritis, injections can help. Generally, I’d recommend starting with low dose cortisone with ultrasound-guidance.
https://sportdoctorlondon.com/cortisone-shot-in-hand/
It is common after an injection to experience a flare, which can last for 2-3 days. Usually, I recommend timing the injection so you have a few days off work.
see this blog on information on cortisone flares and how to treat:
https://sportdoctorlondon.com/do-you-need-to-rest-after-a-cortisone-injection/
LM