Osteoarthritis

Injection therapy is usually offered in osteoarthritis when first line treatment is no longer effective. First line treatment includes physiotherapy, simple pain-killers, activity modification and weight control. More detail on management options can be found in our patient information leaflet on osteoarthritis.

What does the procedure involve?

The majority of injections for osteoarthritis are clinically guided. This means the doctor finds the correct location to place the needle by palpation (feeling) of the joint. In some cases, usually in severe osteoarthritis or certain joints like the hip, the use of ultrasound maybe required to guide the needle into the correct place. The injections can be administered either in the doctor’s office or the procedure room.

At Sportswise we offer 3 types of injections for osteoarthritis.

Corticosteroid injection

What is a corticosteroid?

Corticosteroids (steroids) are medications that mimic the effects of the hormone cortisol which is produced naturally by the adrenal glands. It helps by reducing inflammation. The difference with anti-inflammatory tablets is that the medicine is placed in high concentration into the painful area, thus targeting the area of arthritis. The corticosteroid is usually given with a small amount of local anaesthetic which temporarily numbs the area whilst the injection is given.

What are the potential benefits?

For the majority of patients, it is an effective procedure with reduction of pain and swelling and increased function for the individual. The majority of patients will have a good response to the injection, particularly if they have swelling of the joint. Occasionally the response can be minimal and this is usually related to an increased severity of disease. A distinct benefit is that the relief of inflammation is more rapid and powerful than with traditional anti-inflammatory medications e.g. ibuprofen and can avoid certain side effects such as irritation of the stomach.

Hyaluronic acid injection

Platelet rich plasma and hyaluronic acid injection

What are the risks?

Disadvantages of corticosteroid injections are the necessity to pierce the skin as well as side effects. It should be emphasized that though each of these side effects is possible they usually do not occur.
Side effects/ complications:

Shrinkage (atrophy) or/ and lightening of the colour (depigmentation) of the skin at the injection site.
Soreness at injection site.
Post injection flare of pain – usually occurs within the first 24 hours of the injection and causes aggravation of the inflammation already there.
Tendons can be weakened by injections but we recommend rest for a period of time following the injection so this is unusual.
Facial flushing may occur.
Those with diabetes may have an elevation of their blood sugar.
There is a small risk of infection (<1:20,000).

How many corticosteroid injections can someone receive?

There is no absolute maximum number a person may receive. The risk of side effects increases as the number of injections increases and so the risk and benefits of each injection are considered carefully prior to administration. It is unusual to give steroid injection in the same location on a routine basis.

How often can I have a corticosteroid injection?

How often corticosteroid injections are given varies. Your doctor should discuss your specific case with you and the likelihood, advantages and disadvantages of further injections.

What is hyaluronic acid?

Hyaluronic acid is a natural component of synovial fluid that can be found in joints. Synovial fluid in arthritic joints is thinner and less viscous (less thick) than that found in healthy joints and so provides less shock absorption and joint surface protection. Hyaluronic acid injections lubricate the joint and can also have anti-inflammatory effects. At Sportswise, we use a preparation called Ostenil Plus which is normally given as a course of three injections at weekly intervals but the exact regime will depend on the patient’s response.

What are the potential benefits?

They have been shown to reduce pain and improve function. It has been shown that in individuals who show positive benefits repeating the injection can increase the duration of symptom relief. They do not have a lot of the side effects that corticosteroid injections have and on that basis repeated courses of injections can be used if indicated.

What are the risks?

Hyaluronic acid injections have very few side effects, although some people may have a slight allergic reaction which causes temporary pain and swelling in their joint after the injection. There is also a small risk of infection (< 1:20 000).

Can I have repeated injections?

Other than the very small risk of infection there are minimal disadvantages to repeated injections. Your doctor will assess your case on an individual basis and discuss the option of this with you.

Platelet rich plasma and hyaluronic acid injection

The hyaluronic acid injection described above can also be given with platelet rich plasma (PRP) as a combined injection.

What is platelet rich plasma?

PRP is human blood that is spun down and separated in a machine (called a centrifuge) to produce a portion of your blood (plasma) that is high in platelet concentration. Platelets are the clotting cells in our blood but can also have additional effects on injury healing. Studies suggest that platelets produce growth factors that are thought to stimulate growth of cartilage cells, leading to cartilage repair and can therefore treat osteoarthritis.

At Sportswise, PRP is prepared by your doctor. A small syringe of blood is taken from the patient’s arm into a syringe containing hyaluronic acid. The whole blood is spun in the centrifuge to remove the red blood cells and then the PRP/Hyaluronic acid mixture can be injected into the affected joint.

What are the potential benefits?

PRP injections aim to promote cartilage repair, providing relief for osteoarthritic symptoms (such as pain, stiffness and swelling) and potentially delaying the need for joint replacement surgery. They have been shown to improve pain, activities of daily living, sport, quality of life and can delay recurrence of pain. However, effects are not guaranteed; therefore it is not a first line treatment and only considered after other treatments have not worked.

What are the risks?

Overall, an injection of PRP with hyaluronic acid is a safe treatment with no risk of allergic reaction to the PRP component, since it your own blood. However, some people may have a slight reaction to the hyaluronic acid. As with any joint injection, there is a risk of infection, bleeding and pain.

What joints can be injected?

In practice almost any peripheral can be injected if required.

Some of these injections can be made clinically guided and some require ultrasound guidance for more accuracy.

Ask your consultant about any joint issues you have to see if it may be suitable for injection but the most common joints that we injection include:

Usually Clinically-Guided

Knee
Ankle
Finger joints
Acromioclavicular (Collar bone)

Usually Ultrasound Guided

Hip
Shoulder and rotator cuff tendons
Big toe joint
Wrist

If you would like to make an appointment or have any questions please contact the administration team.
Telephone: 01323 745970 • E-Mail: reception@sportswise.org.uk