Joint injections, including Steroid and Hyaluronic Acid

What is the purpose of it?
Joint injections are usually done to treat the pain associated with arthritis. The steroid (cortisone) injected reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation/irritation of the joint and surrounding structures. Hyaluronic acid is a natural lubricant found in joints, and may be abnormal in joints compromised by arthritis. There are commercial preparations of hyaluronic acid that can be injected into the joint, which are thought to help normalize the joint fluid and provide symptomatic relief of pain.

How long does the injection take?
The actual injection takes only a few minutes, but the preparation may take up to 10 minutes.

What is actually injected?
For steroid injections, a long-acting steroid, such as methyprednisolone combined with local anesthetic is customary. For hyaluronic injections, there are several brands: Euflexxa, Hyalgan, Orthovisc, Supartz, Synvisc, and Synvisc-One.

Will the injection(s) hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a “tetanus shot”). So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle into the joint.

Will I be “put out” for this procedure?
No, this procedure is usually done in the doctor’s office.

How is the injection performed?
The patient is placed in a reclining position on the back with the knee slightly flexed and resting on a pillow. This allows for best access to the knee joint along the lower outer portion of the kneecap. Sometimes joint fluid will be withdrawn prior to injecting the medication.

What should I expect after the injection?
There may be an aching feeling soon after the injection. When local anesthetic and steroid are injected, the knee usually feels numb and the pain may be gone temporarily. With hyaluronic acid injections, there may be a minor buildup of joint fluid. Rarely, there can be an inflammatory flare-up of pain, which may last up to a week.

What should I do after the procedure?
Apply ice the first day and avoid heavy weight-bearing activity for 48 hours.

Can I go to work to work the next day?
Yes, as long as your work does not involve strenuous activity or heavy lifting.

How long does the effect of the medication last?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 5 to 7 days and its effect can last for several days to a few months. Hyaluronic acid injections may last from several months to a year.

How many injections do I need to have?
For steroid injections, we limit this to 3 per year, but only repeat as necessary. For hyaluronic acid injections, the number of injections varies according to manufacturer’s recommendations from 1 per week for 5 weeks (Supartz) to only 1 injection (Synvisc-One).

Will the Joint Injection help me?
It is very difficult to predict if the injection will indeed help you or not. However, those who respond initially, often continue to respond in the future.

What are the risks and side effects?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, and worsening of symptoms. Risks related to the use of steroids include weight gain, increase in blood sugar (mainly in diabetics), water retention, and suppression of body’s own natural production of cortisol. Fortunately, the serious side effects and complications are uncommon. Side effects to hyaluronic acid can include a temporary worsening of pain, swelling, and redness of the joint.

Who should not have this injection?
If you are allergic to any of the medications to be injected, you should not have the injection. Your doctor may take you off of blood thinners prior to the procedure. If you have an active infection, your doctor may choose to wait until this has resolved before performing the injection.