Injections for Knee Pain

You may have either read or heard about "injections" for knee pain. 

The main driver for pursuing injections, for most people, is pain relief. But, as you'll learn, some injections may relieve pain at the detriment of your joint.

There are several types of knee pain injections that physicians use. I'm going to cover the more common ones you're apt to hear about and how those injections impact joint health.

Corticosteroids

These are anti-inflammatory drugs (cortisone) that effectively squash the immune system response to inflammation. The result is less knee pain and swelling.

Cortisone is commonly used in the treatment of knee arthritis and it can be an effective pain reliever although that relief is often shortlived.

A problem though with cortisone is that it can accelerate joint deterioration even though you might feel better from the injections. [source]

Some patients think of cortisone injections as a good strategy to avoid knee replacement surgery. And some doctors often consider the injectons to be harmless.

But, the effectivenss of the cortisone injections seems to diminish over time and can increase the volume of cartilage loss. [source]

Synvisc 

Synvisc is a brand name for a chemical, like a gel, that mimics the fluid in your knee joint - the synovial fluid - and is referred to as viscosupplementation. One of the main components of the synovial fluid is hyalouronic acid (HA) and the various brands of the injectable substance have different weights of HA.

The injectable HA helps improve the lubrication of the knee joint and provide some cushioning. Compared to cortisone, HA injectables have much less risk and tend to be more helpful to people wth knee arthritis. [source]

They seem to work for about four to six months at which point you likely will have to repeat them.

Platelet Rich Plasma

Platelet Rich Plasma (PRP) is created by separating the platelets in your blood which is then injected into the injured tissue.

The platelets contain "growth factors" - specialized proteins -  that amplify the healing process, stimulate stem cells, encourage new blood growth, start collagen synthesis, and help with new cell growth and new tissue regeneration.

After an injection (and often times, you'll have more than one in a session and, in some cases, more than one session), there's a period of inflammation and you could feel worse for a few days to a week. This generally goes away and is then followed by a multi-step process of gradual healing and strengthening of your knee joint.

A PRP injection helps improve your joint health while also helping you feel better and when combined with joint-focused strengthening and rehab, can be quite effective. 

PRP injections seem to work better than the gel-type injections although often have to be repeated. [source] And they are generally not covered by health insurance.

Stem Cell Therapy

Stem cells are like "master cells" of the human body. They can repair, replace, or regenerate all types of body cells and therefore have the potential to treat a wide cariety of conditions and diseases.

The only FDA-approved stem cells are derived from cord blood and are called hematopoietic progenitor cells. These stems cells are used to treat cancer and disorders of the blood and immune system.

When it comes to treating orthopedic conditions like knee arthritis, stem cell injections are not FDA-approved and are considered experimental.

The most common procedures used to create injectable stem cells are harvesting bone marrow from the back of your pelvis or from adipose tissue.

The FDA requires that the injectable stem cells be injected in the area of the body from which they came. Most stem cell clinics in the US do not follow that regulation and instead, for example, harvest stem cells from bone marrow, process those cells in a lab and then inject the cells into injured areas of the body like your knee.

The effectiveness of stem cell injections for orthopedic conditions varies likely due to the different technical processes that physicians use and the type of physical rehab that follows the injection. [source]

If you’re thinking of pursuing stem cell injections for orthopedic conditions, the safest plan is to make sure the procedure is either FDA-approved or is part of an Investigational New Drug Application (IND) - a clinical investigation plan approved by the FDA. 

The FDA has issued recommendations to help consumers make decisions regarding stem cell therapy.

Good Idea or Not?

Of the injection types listed above, PRP and Viscosupplementation appear to offer some relief from arthritis knee pain and, in the case of PRP, potential for a healthier joint.

Thanks for reading.