Gel Injections for Knee Arthritis Pain

Gel injections are one of the types of pain relieving injections that Westchester Sport and Spine performs for arthritis, mostly in the knees but, we’ve done them occasionally in shoulders, ankles and in the hip.

Gel injections are really hyaluronic acid which is a normal part of a normal joint that helps to lubricate the joint.

When you have arthritis the levels of that lubricant, of the hyaluronic acid, is decreased. So what we do is inject this gel into the joint and it acts as a lubricant between the bone. That helps 85 percent of people for an average of six months.

Gel injections help 85% of people for an average of 6 months.

– Dr. Rick Weinstein, Westchester Sport and Spine

I’ve had patients I’ve done these injections on and they’ve held for up to two years. In my office the way I do these injections is using ultrasound which helps to ensure that we’re getting into the joint. There’s been a couple of studies that show if you don’t use ultrasound, you’re much less likely to get it into the joint.

So, ultrasound helps to improve the chances that the injection is going where it’s supposed to go.

What If I Don’t Improve With Injections

People who don’t improve with the injections, and I should add that we try physical therapy for most people and almost everyone does get some improvement with physical therapy.

I’ve even had success with people with severe arthritis who go to physical therapy and are much improved afterward. I’m always surprised that there are some other doctors out there, even some other orthopedists and some other specialists like myself, who don’t send patients to therapy and tell him immediately you need surgery.

I think that’s a mistake.

If you try physical therapy, it helps. If you try injections, it helps. And if you can avoid surgery you’re better off.

The patients who don’t get better with the therapy and the different kinds of injections, then it’s time to consider surgery.

And the main surgery for arthritis is joint replacement surgery. And that’s extremely successful. And that surgery is done by basically cutting off the arthritis and replacing it with either metal or plastic. So surfaces are not grinding against each other.

Understanding Arthritis Pain

When someone has arthritis it’s important to understand that the cartilage on the end of the bone actually doesn’t have any nerve endings. It’s the bone underneath it or the cells around the joint. So when someone has arthritis they’re getting swelling in the knee and the bone underneath the cartilage could be getting the pressure.

The pressure is what’s causing the arthritis pain. So if someone has mild arthritis they may have no pain at all. I’ve even had some patients that have significant arthritis in a joint and they’re not really having that much pain. I have some patients who have mild arthritis and have severe pain.

Part of it is how you’re dealing with the pain and part of it is how the nerves are exposed inside that joint.

Using Anti-Inflammatories For Arthritis Pain

There are anti inflammatories including over-the-counter medicines such as Aleve or naproxen, ibuprofen, Motrin, which are somewhat effective. Tylenol is not very effective for arthritis pain but people can try that also to see if it works for them. Usually by the time someone comes to see me, they’ve already tried some anti-inflammatory medication.

When the pain is really severe I may (rarely) prescribe a stronger medicine, but that’s just for the short term only. People should not be depending on these pain medications to fix their arthritis.

The pain should not be that bad that they need a narcotic, but on occasion they might for a short term. We don’t recommend prescribing too much pain medication.

When Conservative Treatment Fails

When people have arthritis and conservative treatment fails, and by that I mean physical therapy, exercises, injections, then it’s time to consider surgery.

One of my patients has done therapy for her hip and she was not getting better. But when I went specifically saw what she was doing, they were not doing any real exercise for her hip. They just told her to go exercise on her own and weren’t supervising her. So I don’t think she failed physical therapy.

I sent her to a physical therapist that I know is excellent and if she is still not getting better then I would talk about more aggressive treatment such as surgery.

But until someone gets real good physical therapy it’s not right to say go get surgery.

Don’t Delay Treatment

If you have something catching or rubbing inside the knee and you don’t deal with it, it can make things worse. A patient with a loose piece of arthritis bone or cartilage floating inside the knee can cause more damage. You absolutely want to get that diagnosed.

The worst thing is when patients start to lose motion in a joint and then they are not getting that motion back. Oftentimes physical therapy and anti-inflammatories get that motion back, but if you don’t, you don’t want to live like that because you may never get it back including after having surgery.

If you’re starting to lose motion and the pain is getting bad, you really need to see your orthopedic specialist as soon as possible.

Don’t blow it off because otherwise you’re going to have severe loss of motion of that joint.

Contact us today if you have any concerns about arthritis pain.

 

Dr. Rick Weinstein, MD, MBA is an orthopedic surgeon specializing in sports medicine. He is the Director of Orthopedic Surgery at Westchester Sport and Spine and has subspecialty training in knee and shoulder surgery, including minimally invasive surgery and arthroscopy. Dr. Weinstein is a Board Examiner for the American Board of Orthopedic Surgeons, determining certification for other orthopedic surgeons.