Hyaluronic acid (viscosupplementation) injections tend to work more slowly than cortisone—the full effects may not be felt for about 2 weeks—but the effects may last longer. The primary goal of a hyaluronic acid injection is to lubricate the knee joint.
You'll likely receive a cortisone shot, also called a steroid injection, as a first-line treatment. Cortisone shots are effective for many patients in quickly reducing inflammation and pain directly inside the joint, but they come with a few precautions.
nSTRIDE® is the only single-injection therapy where the benefits are sustained for up to 3 years. There is a small injection into your knee joint which is designed to alleviate pain and reduce inflammation of the knee.
Cortisone injections for arthritis
Cortisone is the most commonly used injection. We know cortisone 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.
Hyaluronic acid injection is used to treat knee pain caused by osteoarthritis (OA) in patients who have already been treated with pain relievers (e.g., acetaminophen) and other treatments that did not work well.
In this procedure, a gel-like fluid called hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads.
UNM Researchers Inject Patients' Own Fat Tissue to Alleviate Pain. In a novel study, University of New Mexico researchers have shown that injecting a patient's own fat cells into arthritic knees is more effective at reducing pain and preserving function than other treatments.
Implantable shock absorber provides superior pain relief and functional improvement compared with high tibial osteotomy in patients with mild-to-moderate medial knee osteoarthritis: A 2-year report. Cartilage. Published online February 23, 2023.
Cartilage Regeneration Options
MACI is a surgical procedure that uses cartilage-forming cells from your body to restore damaged cartilage in the knees. It involves a biopsy to harvest chondrocytes (cartilage-forming cells), which are allowed to multiply in a lab, and surgery to implant them into the damaged area.
Generally, if the first shot doesn't work, we may inject the same area again after 6-8 weeks. However, if a second shot doesn't work, we don't recommend a third shot. But, you can have multiple cortisone shots in different parts of your body.
The idea behind these injections is that they will temporarily restore the natural function of the knee by injecting a substance which will provide cushioning and reduce bone-on-bone contact. Individual responses vary, but many patients experience months, if not potentially a year or more of relief.
You can only have three cortisone injections in a lifetime
Generally, if the first injection doesn't work, the second and third probably won't either. Moreover, you should limit yourself to 2-3 injections in one area over 3-6 months. However, the rule that you can only have three in a lifetime is invalid.
How Does Medicare Cover Knee Injection Treatment? Medicare will cover knee injections once every six months if they are medically necessary. The injections are covered under Medicare Part B and subject to the annual Part B deductible.
Cortisone injections tend to work quickly, and provide relief, but this can be as short as a few weeks or as long as several months. The gel injections tend to be effective for about 50% of patients, but for those that it works well for those patients tend to see improvement in VAS scores for at least 4-6 months.
So doctors typically limit the number of cortisone shots into a joint. In general, you shouldn't get cortisone injections more often than every six weeks and usually not more than three or four times a year.
Most people see pain lessening and their mobility improving for several months, often as much as 6 months. The key concern here is that the use of these knee injections has to be limited because of the medication within them. They can only be used 2 or 3 times a year for most people.
Rest, Ice, Compression, and Elevation. Your doctor may recommend the RICE regimen—rest, ice, compression, and elevation—to treat a knee cartilage injury. Resting your knee can help reduce the symptoms associated with the injury.
Joint Injections. People with moderate to severe knee cartilage loss may benefit from injections directly into the joint. Options include corticosteroids, hyaluronic acid, and platelet-rich plasma (PRP). Combination intra-articular injections can also be effective for people with no knee cartilage.
Regenerative Stem Cell Therapy
Stem cell knee therapy is becoming a popular alternative to knee replacement surgery. Through a method known as autologous transplantation, the cells are extracted from the patient's bone marrow or fatty tissue, processed, and immediately injected into the damaged knee.
Wake Forest Institute for Regenerative Medicine (WFIRM) scientists have created a promising injectable cell therapy to treat osteoarthritis that both reduces inflammation and also regenerates articular cartilage.
In the United States, currently, the average age to undergo knee arthroplasty is around 65 years old. Mostly knee replacement surgery is performed in elders with severe arthritis, while those under the age of 50 are considered young and are asked to wait until the age of 65.
Non-Invasive Treatments
Ice and over-the-counter pain medication like acetaminophen or ibuprofen can help. Sometimes physical therapy or a guided exercise program can provide bone-on-bone knee pain relief by strengthening the muscles that support the knee, particularly the quadriceps.
What is SYNVISC? SYNVISC is a viscosupplement injection that supplements the fluid in your knee to help lubricate and cushion the joint, and can provide up to six months of osteoarthritis knee pain relief with three injections.