Patients are often familiar with a “shot” for their knee pain. But what’s in these shots and what’s the difference? Let’s talk about how these work and what options are available. Knee pain usually comes from inflammation. There are many causes of inflammation such as sprains and strains, but most commonly arthritis. Today we will focus mainly on arthritis – a natural wear and tear of the knee cartilage.
Treatments for arthritis of the knee includes a wide range of options from arthritis medicines to surgical procedures or knee replacement. Injection treatments are a quick way to get 100% of the medicine straight into the knee without the side effects of oral medicines. There are several injection treatment options but the two most common are cortisone shots and viscosuplementation. There are also other injection treatments for the knee such as Platelet Rich Plasma (PRP) and Stem Cells therapies. These are promising but not widely covered by insurance. I will talk about these in future post.
What’s the difference?
Cortisone shots are mainly a steroid that is a powerful anti-inflammatory medicine. This is usually mixed with a numbing medicine and injected into the knee. It works quickly but may not last very long. Maybe 2-6 weeks. It is a good way to get quick relief and confidence that the inflammation in your knee can be managed.
Viscosupplementation goes by many names, “rooster shot” or “lubricant”,and by the various branded names Supartz, Orthovisc, Synvisc, or Euflexa.
What’s in it for my knee cartilage?
Our knee cartilage makes a natural substance call Hyaluronic acid that nourishes and lubricates the cartilage in your knee. As we mature or damage the knee cartilage our body make less volume and a diminished quality of this substance Hyaluronan. Fortunately, scientist have developed a way to synthetically make Hyalron in the lab so that we can inject it back into the knee and supplement your own natural lubrication. Because it is so concentrated it is often injected over several weeks in smaller doses. Studies have shown that it will actually stimulate your knee cartilage to produce more of the natural Hyalron substance itself. It works best for mild to moderate wear of the knee cartilage. Most of my patients report improved range of motion and less pain after completing the series of injections.
Which one should I get?
I usually recommend that a cortisone shot be tried first. It works quickly but does not last long. If you get good relief from this but it only last a few weeks then try the viscosupplementation injections which should last longer, maybe 6- 12 months.. Unfortunately if you don’t get relief from the cortisone shot or there is still a painful catching or locking then you probably will not get much success from the viscosuplementation and should talk with your doctor about other options.
Now you understand that not all “shots” are the same. Work with your doctor to understand the cause of your pain. . If it is due to the knee cartilage you may be able to discuss one of these injection treatments. Come talk with me and we can figure out together what is the best option for you.