In the UK approx. 8.5 million people suffers from Osteoarthritis (OA). What would be the best injections for knee pain associated with OA?
OA in the knee is found in around 1 in 5 people over the age of 45 in England. Despite a large portion of the population suffering with this condition there has been little meaningful help available other than pain medication and knee replacement surgery, until now.
What is OA?
Arthritis occurs when the cartilage of the joint wears away, exposing bone. This bone exposure leads to pain, inflammation, swelling, stiffness, and reduced function.
Generally, simple interventions such as exercise and weight loss have the best effect on managing arthritis, but when there is a lot of pain the motivation to stay active goes down and you end up in a spiral of reduced activity, muscle wastage and often weight gain, all of which can accelerate OA like a steam train.
How can knee injections help?
Injections for knee pain can be an extremely effective way to get both quick and long-lasting results when dealing with OA knee, and in some cases completely divert you away from a knee replacement surgery*.
Knee injections can help slow down the progression by controlling the pain and inflammation in the knee joint and allow you a window of an opportunity to start some serious rehabilitation to build up a long-term protection around your knee joints.
Let’s have a look at the different options of knee injection currently available on the market.
Cortisone is one of the most commonly used injection drugs. We know cortisone is a potent anti-inflammatory drug that reduces inflammation, swelling, and pain and is a type of injection widely used in the NHS as well as in private practice.
Cortisone has a little bit unfair reputation as there is some evidence suggesting more cartilage wear or increased risk of needing a knee replacement earlier, but it is important to mention this is with repeated long-term use of cortisone. The evidence is not very strong, so we always have to weigh up pros and cons when using cortisone to ensure we make a good decision.
Overall, studies show short-term improvement in knee pain after a cortisone injection. Generally, the cortisone effect is better in milder knee arthritis cases and lasts up to 3 months.
Are Cortisone injections available at Bode Clinic? YES
Platelet-rich-plasma, also known as PRP, is obtained from your blood. Blood is taken from your body and this blood is spun in a centrifuge to concentrate the platelets and separate them from the other cells. We then inject this plasma into the knee joint. Platelets release growth factors, which induce healing and pain reduction.
The evidence on PRP injections is showing minimal effect for OA compared to cortisone and hyaluronic acid, the procedure is expensive and therefore not a widely used treatment option for OA.
Are PRP injections available at Bode Clinic? No
A new kid on the block is Arthrosamid® – officially launched to the UK market at the British Orthopaedic Association (BOA) Annual Congress, 21st-24th September 2021.
Arthrosamid is a unique hydrogel of water molecules attached to a polyacrylamide backbone. It works by coating the lining of the synovium of the knee joint, reducing inflammation, and providing lubrication.
The injectable is non-degradable, meaning the body does not break it down, and therefore as injection therapists we would highly recommend you have this injection done with guidance. Given the lack of higher-level studies regarding Arthrosamid we have not started offering this type of drug at Bode Clinic, but we are keeping a close eye on the evidence being produced.
Ostenil is a hyaluronic acid which is a natural substance found in bones, joints, and tendons. In a diseased joint, like OA, the natural amount of hyaluronic acid reduces. Ostenil is injected into the space between the joint that contains synovial fluid and works to restore the balance between the breakdown and production of hyaluronic acid.
For a large joint like the knee, we prefer to use Ostenil ® Plus. The hyaluronic acid in OSTENIL® PLUS is very pure and is manufactured using fermentation. Containing no animal proteins, it is unlikely to cause an allergic reaction, plus the addition of mannitol (a sugar derivative) helps the hyaluronic acid to work for longer and more efficiently in the joint. This effect means OSTENIL® PLUS can help decrease pain and stiffness of the joint.
OSTENIL® PLUS has been extensively tested and has not been found to cause any serious side effects, plus it contains no animal proteins, so is unlikely to cause an allergic reaction.
Bode Clinic is one of Manchester’s very few Ostenil ® approved clinics, meaning we are recognised for our high level experience and knowledge when it comes to joint injections.
Which is the best injection for knee pain?
Cortisone injections work best for those people who need a quick pain-relief fix. Usually, people with swollen and painful joints are most suitable for a cortisone injection but it has limited long term relief for OA. A perfect example for use of cortisone would be a swollen knee joint from acute gout.
With Ostenil studies show overall a good effect on pain of osteoarthritis that can last for up to 6-12 months making hyaluronic acid a reasonable option for mild to moderate knee arthritis.
With cortisone we do recommend a week of rest following the injection, after Ostenil there is no downtime, and you can stay active.
Also, Ostenil injections are suitable for people who are allergic to steroids or can’t use steroids for medical reasons or sporting regulations.
There are many things to consider when deciding which treatment options to choose, and in each case we recommend to have a conversation with your physiotherapist to decide which could be your best option.
At Bode Clinic we have used knee injections as a treatment method for several years and are one of the very few specialist clinics in Manchester outside hospital settings offering this treatment. Having excessive training and experience in joint injection techniques and offering prescriptions in house, we can offer a quick and efficient treatment for your knee OA.
We hope you found this article useful and maybe you have a little bit wider understanding of the treatment options available for OA knee.
You can book in for a FREE consultation with any of our physiotherapists at Bode Clinic, simply click here and find your day/time for your 15min chat. And remember, we offer phone calls/ video calls to help accommodate for patients who are not living locally to our clinic.
*knee replacement surgery can sometimes be the only solution on very severe late stage OA. However regardless of the stage of OA you will need rehabilitation both before and after surgery, and there are cases where knee injections can delay the surgery and give you a better outcome post surgery. Please do not hesitate to discuss you options, receive second opinions, ensure you make a informed educated decision for your knee OA.