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Joint Injection Treatments for Osteoarthritis

Joint injections or aspirations (taking fluid out of a joint) are performed often with local anaesthesia. After the skin surface is thoroughly cleaned, a needle in injected directly into a joint. At this point, either joint fluid can be removed (aspirated) and used for appropriate laboratory testing. Steroids, Platelet Rich Plasma (PRP) or adipose ( fat ) derived Stem Cells can be injected into the joint according the indication of treatment. These treatments can treat inflammation inside the joint, leading to decreased swelling and pain with to effective pain management and in turn translate into a better quality of life.

Commonly injected joints include the knee, Hip joint, shoulder, ankle, elbow, wrist, base of the thumb, and small joints of the hands and feet.

  1. Joint injections are used to deliver the therapeutic agent  directly into a joint, such as a knee, ankle, or wrist. Sometimes fluid is removed from the joint before the steroid is injected.
  2. Steroid joint injections can help with pain and swelling by treating the underlying joint inflammation – improvement is often quick.
  3. The risks for joint aspirations and injections are minimal. Infection, bleeding, and other risks are rare.

What is a joint aspiration or joint injection?

Steroid joint injections can be used as part of a treatment plan for people with arthritis. A medication/PRP/Stem Cells is injected using a needle directly into a joint, such as a knee. The steroid treats the inflammation inside the joint, leading to decreased swelling and pain.

Sometimes joint fluid is removed before the steroid is injected (called aspiration), and then the therapeutic agent is injected into the joint, without requiring a new needle stick. Fluid obtained from a joint aspiration can be examined by the physician or sent for laboratory analysis, which may include a cell count (the number of white or red blood cells), crystal analysis (to confirm the presence of gout or calcium pyrophosphate crystal disease), and/or culture (to determine if an infection is present inside the joint). Drainage of a large joint effusion can provide pain relief and improved mobility.

The decision to use joint injections as part of a treatment depends on each individual case. Joint injections may decrease the accumulation of fluid and cells in the joint and may decrease pain and stiffness. The positive effects of joint injections are for pain management and better quality of life and may not be permanent. Often, the improvement in inflammation, swelling and joint pain lasts a long time before needing another treatment, but depends on the extent of the joint osteoarthritis. In some milder conditions, a joint injection may produce long periods of disease control.

Steroid joint injections may be given to treat inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendonitis, bursitis and, osteoarthritis.

 

How is a Joint Injection usually given?

Joint injections can be performed safely in the clinic. It is important for the patient to stay still during the procedure. Hyaluronic acids and corticosteroids (such as methylprednisolone and triamcinolone formulated to stay primarily in the joint) are frequently used. Corticosteroids are anti-inflammatory agents that slow down the accumulation of cells causing inflammation and pain within the joint space.

When it is time for the injection, the skin at and around the injection site will be carefully cleaned to remove bacteria from the skin. A needle is then inserted into the joint space. If the plan is to remove fluid, an empty syringe will be attached to the needle to pull the fluid out. Sometimes, multiple syringes need to be used to remove all the fluid. After any necessary fluid is removed, a small syringe containing the therapeutic agent is attached to the needle and is slowly injected into the joint. The needle is removed, and pressure is held to prevent any bleeding. A bandage is applied to the injection site.

 

Possible Risks/Side Effects

Infections are very rare complications of joint injections. Another uncommon complication is post-injection flare – joint swelling and pain several hours after the injection – which occurs in approximately 1 out of 50 patients and usually subsides within several days. Some patients may have a temporary increase in pain that can last a few days and is usually manageable with pain killer medication,

Other complications, which is associated with a corticosteroid injection treatment may include depigmentation (a whitening of the skin), local fat atrophy (thinning of the skin) at the injection site and rupture of a tendon near the injection site.

Joint injections also should not be given if an infection is present inside or around a joint and if someone has a serious allergy to one or more of the medications that are injected into a joint. If an infection is suspected, aspirating the joint to gather cultures is essential.