As your disease and knee pain progress, your doctor may recommend one of two treatments involving injections directly into the knee joint. The goal of both injection therapies is the same: to help reduce your pain and inflammation. These injections are:
Usually there is slight and tolerable pain associated with the injection. Often, very thin needles are used to perform the injection, causing less pain. However, sometimes your doctor may need to remove fluid prior to the injection, in which case a thicker needle in used. Numbing mediation is often injected with the steroid to provide temporary relief. Some doctors use topical anesthetics to help numb the skin at the area of the injection. If you are concerned about the potential pain of an injection, be sure to discuss this with your doctor before the procedure.1
This is a question that only your doctor can answer. Whether you are a good candidate for surgery depends on a variety of factors, including how far the disease and discomfort have progressed, your general health and other risk factors.
In general, when other, more conservative treatment options such as diet and exercise, pain medication and injections no longer provide you with enough relief to give you the freedom of movement you need in your daily life, more aggressive forms of treatment may be considered. Most doctors limit corticosteroid injections to three—if they fail to provide enough lasting relief, surgery may be one of your only remaining options.
A corticosteroid is a synthetic form of cortisone, a hormone naturally produced by the body. When injected in high doses into the knee, it has a powerful anti-inflammatory effect and can provide fast pain relief.
Steroid injections for knee osteoarthritis should only be used as a short-term treatment, since the duration of their effects can vary and multiple injections can damage cartilage and connective tissue. Most doctors limit the number of injections to three.
Yes. The most common side effect is something called a cortisone flare, which occurs when the cortisone crystallizes and causes pain worse than before the injection. This usually goes away on its own in a day or two and can be treated with ice packs. Another common side effect is whitening of the skin at the site of the injection. Patients with diabetes may experience an increase in their blood sugar which should be carefully monitored.
These medications can also have rare but serious side effects at high doses and when taken for long periods of time. The most serious is infection. Other side effects include weight gain, facial puffiness, thinning of the skin and bone, easy bruising, cataracts, risk of infection, muscle wasting and destruction of large joints, such as hips.1
Osteoarthritis of the knee can cause joint fluid to become less healthy, and the cartilage begins to break down. This leads to irritation, discomfort, soreness and swelling in the knee.
The hyaluronic acid used in a viscosupplementation treatment like ORTHOVISC® is a chemical found in healthy joint fluid. The viscosupplementation injection acts as a lubricant and shock absorber in your knee joint, providing anti-inflammatory relief and slowing cartilage deterioration.
Injectable hyaluronic acid is either derived from rooster combs (the crown of feathers on a rooster’s head) or bacterial cultures. Unlike hyaluronic acid that comes from avian sources, bacterial hyaluronic acid such as ORTHOVISC® will not cause an allergic reaction in people who suffer from avian allergies, which includes allergies to poultry, feathers or eggs.
With just three or four consecutive, weekly injections, ORTHOVISC treatment can provide up to six months of knee pain relief. Everyone responds differently, but some people experience pain relief after the first injection.
The full ORTHOVISC treatment cycle consists of one injection a week for three or four consecutive weeks. Although individual results may vary, some people feel relief after the first injection.
An ORTHOVISC injection usually only takes a few minutes, and most patients experience little or no discomfort.
The doctor will usually begin by cleaning the injection site with alcohol or iodine. A local anesthetic may also be administered to numb the knee and make the ORTHOVISC injection as comfortable as possible. If there is excess fluid in the knee joint, the doctor may choose to remove it prior to performing the injection.
You will be able to go home immediately after your ORTHOVISC injection. You should have no problems walking or driving. However, you should avoid putting a lot of strain on your knee for 48 hours after treatment, refraining from activities such as tennis, jogging, heavy lifting or prolonged standing.
If you have any known allergies, talk to your doctor to determine if you can take ORTHOVISC®. For the first 48 hours after each injection, it is recommended that you avoid strenuous activities (e.g. jogging, tennis, heavy lifting).
The most commonly reported side effects are joint pain, back pain and headache. Others include temporary pain at the injection site, which can be treated with an ice pack as directed by your doctor. ORTHOVISC treatment should not be given to patients with infections or skin diseases in the area of the injection site. Any persistent side effects should be discussed with your doctor.
Talk to your doctor about all the medications you are currently taking. Your doctor must know your medical information to make the best decision about your treatment plan.
The number of courses/injections is a decision you and your doctor need to make. Your doctor may recommend three or four ORTHOVISC injections. Studies show that retreatment with ORTHOVISC is safe following the initial 6-month treatment period. Consult your insurance provider to find out about coverage for any retreatment’s you may receive.
Most insurance carriers cover ORHOVISC. See the article titled, “Does your insurance plan cover corticosteroid or ORTHOVISC injections?” to learn more.
DePuy offers patients free information kits with a more detailed discussion about ORTHOVISC treatment.
See an animation of a knee injection procedure.