Knees and Needles
I am a well-scarred veteran of the knee wars. Even before my total knee replacement on the left side, I’d had multiple arthroscopic procedures and numerous office visits to address knee pain. It’s really not surprising. Knees can be damaged both by osteoarthritis as well as rheumatoid arthritis, so even if you don’t develop inflammatory arthritis, simple wear and tear over the years will take its toll on your knees. Even everyday activities can cause strain and sprains on these weight-bearing joints.
Well before surgery is even contemplated, doctors have a number of therapies available to them including physical therapy, bracing, RICE (rest, ice, compression, elevation) and similar manual techniques. There are also three frontline weapons in the physician’s arsenal involving needles. I am living proof that all three of these can provide welcome relief.
Steroid injections. While taking prednisone provides an overall reduction in inflammation, steroid injections provide medication to a very precise location to address specific pain, such as in the knee. Steroid injections are usually very effective when the problem is caused by inflammation, either by rheumatoid arthritis or through acute injury or osteoarthritis. Often the injection will contain a local anesthetic that helps provide immediate pain relief while the steroid will provide improvement for weeks or even months. All of my knee steroid injections have been administered in the office by my orthopedic surgeon. These can also be given by your rheumatologist or you might be referred to an orthopedist or even a specialized radiologist who will use a fluoroscope to help position the injection in just the right location. The major downside to steroid injections is that they can damage the cartilage in the joint, so there is a limit to how many and how often steroids can be injected.
Hyaluronic acid injections
Hyaluronic acid injections. Hyaluronic acid is similar to a substance that occurs naturally in the human body. In the knees, it acts as a cushioning and lubricating agent, absorbing shock and helping the knee move smoothly. In people where other methods haven’t worked well, doctors will consider this treatment. I had several steroid injections over the course of time before my doctor suggested hyaluronic acid injections. You’re actually increasing the volume of fluid in the knee so my doctor suggested that the injections might be painful, but I tolerated them fine and didn’t really notice much difference than a standard steroid shot, which can sting. When I got my treatment, the standard was an injection a week for either three or four weeks, depending on the brand being used (which depended on which branch your insurance covered). My husband recently had the treatment and they’re now offering the option of doing one large injection instead of spreading them out over time. Other than the potential of being allergic to the solution, there aren’t a lot of downsides to this treatment. While it may take a week or two for some people to see the full effects, I got almost immediate relief. I went from not being able to walk across the parking lot to my car to being able to walk several blocks without pain.
Joint aspiration. Also called arthrocentesis, this is when the doctor removes fluid from the joint and the joint most commonly aspirated is the knee. When the joint is swollen, the excess fluid can make the joint painful and difficult to move. Removing excess fluid can correct this problem. Sometimes the knee is aspirated to remove fluid in order to make room for a steroid or hyaluronic injection. Often the removed fluid is analyzed to determine the cause of the swelling. Joint fluid can provide clues that point to an infection or inflammatory conditions such as RA, leading to a more individualized treatment plan.
In addition to these three mainstream needle-based treatments, injections using stem cells and/or platelet-rich plasma (PRP) are emerging. Whereas the other treatments generally reduce pain and/or inflammation, these new treatments have claims of actually helping to repair and/or regenerate knee tissue. That’s amazing news and has far-reaching implications for other parts of the body. Right now, there is still a lot of research data to be gathered and, to my knowledge, insurance companies may not cover the procedures.
While many of us will face knee problems – if nothing else, through the natural aging process – the good news is that there are both tried-and-true as well as emerging treatments to help solve them.