Steroid (Cortisone) Injections
What are they?
Corticosteroid injections help reduce and interrupt the process of inflammation in your joint. The reduction in inflammatory chemicals in your joint helps reduce pain. The result is a temporary reduction of pain, and an increase in your activity levels.
Approximately 80% of patients will report reduction of their joint pain with this treatment. This will last anywhere from 2 weeks to 2 months with most receiving pain relief for about 6 weeks but results are variable.
In conclusion, steroid injections can provide short-term pain relief for arthritis.
Hyaluronic (Gel) Injections
Examples: Gel-One, Synvisc, Euflexxa
What are they?
Hyaluronic acid is a natural component of the fluid in your joint called synovial fluid. As you age, your body slowly loses this vital component, which can help lead to arthritis. Luckily, we can replace this hyaluronic acid with a substitute. This hyaluronic product can be derived from rooster combs or synthetically. The gel injections help to lubricate the joint, leading to reduction in pain and an increase in function.
Most patients slowly see improvement in symptoms but the injection may take 6-8 weeks to achieve results. In general, the results can by summarized as: 1/3 of the patients have great pain relief that lasts 6-12 months, 1/3 of the patients have no symptom relief, and 1/3 of the patients have some relief.
In conclusion, hyaluronic injections take a longer time to work and have a slightly lower success rate than cortisone, but tend to provide longer lasting symptom relief when they do work.
Platelet Rich Plasma (PRP) Injections
What are they?
Platelets are normally found in your own body. When you have a cut or scratch, the scab that forms is filled with platelets. These are special cells in your blood that cause the blood to clot. This clot helps heal an injury by releasing special growth factors. In addition, the platelets can also help reduce some harmful chemicals released by a trauma. Your joint can benefit by the release of these growth factors in a concentrated form.
A small amount of your own blood is drawn and then centrifuged (spun at a very high speed) to separate out your blood cells from your plasma and platelets. A concentration of platelet rich plasma is obtained from this which is packed with growth factors and proteins which help heal damaged tissue. The concentrated solution is then injected back into your knee joint under ultrasound guidance.
If we compare PRP to hyaluronic injections (i.e. Gel-One, Synvisc), PRP patients tend to have better pain relief and improvement in function. The injections typically result in slow improvement over the course of 6-8 weeks. Most studies have looked at patients that received 3 separate PRP injections. Preliminary results indicate that patients may see improvement in symptoms lasting 6-12 months with some patients still seeing benefits for up to 2 years.
Bone Marrow Concentrate Stem Cell Injections
What are they?
Our body stores cells required for repair within specific areas of our body. One such area is within your bone marrow. This is the space within the middle of your bone that is rich in cells used to regenerate damaged cells. Bone Marrow Concentrate Stem Cell treatments can provide a source of stem cells, platelet rich plasma, and plasma proteins.
This procedure is typically done at a surgery center under light sedation by an anesthesiologist. A specially designed needle is used to enter into the middle of your pelvic bone to remove the bone marrow concentrate. This concentrate is then processed and centrifuged to provide a concentrated solution that is injected directly into the area of concern in the knee.
These regenerative cells in your knee can help reduce pain and inflammation and lead to improved function of the joint.
Overall, most of the studies evaluating the use of this treatment have been encouraging but not conclusive. Experience has suggested most patients will have significant relief of pain around 1-2 months post injection. This will often continue to improve for the first 3-6 months after the stem cell procedure. There are patients who will not get any improvement at all from this procedure, probably around 10-20%.