Let's see Why your Doctor Advised you So?

Knee Pain is one of the commonest problems that we come across in our daily practice and the most common reason is Osteoarthritis ( Degenerative Disease) of the Knee.

Now, degeneration is something that is a side effect of Aging. And Since Aging cannot be reversed, the Osteoarthritis of the Knee cannot be Stopped either !!! (But don't worry, an operation is not needed always).

And Sometimes when Oral medicines and exercises do not provide good or expected relief, your doctor may suggest Knee Injections where the Medicine is directly Put Inside your Knee Joint.

So, What are the Various types of Injections Available?

This is quite an interesting thing to Know. We generally have various options but here we will discuss the Three Most Commonly Used ones.

1. Cortisone or Steroid
2. Gel or Viscosupplementation.
3. Platelet Rich Plasma

                       Cortisone or Steroid

Yes, steroids !! This term brings a lot of fear into our minds, but trust me it is an age-old low-cost weapon to treat your knee Pain which even after taking so many medicines is still hurting.

 How does it Work?

 It works by reducing the inflammation in the Joint and suppressing the Pain causing chemicals within the Joints.

How Long will it work?

Generally, we expect it to start working within a day or two and work up to 3-6 Months. 

But if you exercise properly during this "Pain-Free" Period, then the effects of Injection may last for a much longer time. ( Lot of our patients didn't even need another injection)

So, Doctor do we need to Repeat the Injection?

Sometimes, if the effect goes away sooner, a second dose may be planned in 3rd or 4th month from the 1st Injection.

Doctor, is it Painful? 

No, if it's given properly and by an experienced Doctor it will be much less painful than your Covid Vaccine!

Are There any Special things to follow after the Injection?

We generally advise avoiding exercise and excessive activity for the next TWO days!

and Water Contact to the injection site for 24 hours !!

And can I have food before the Injection?

Yes, absolutely. 

What about the Side Effects? 

Even the medicines you take for Knee pain are not free of Side effects !! So, in medical science, a doctor generally looks into a term called Risk-Benefit Ratio and advises you on a thing.

The Side effects of Steroid injections are that you may have is Temporary increase in Pain, Infections (if the procedure is not done properly or in a sterile environment).

“Steroid arthropathy”: It's a relatively dangerous one !! but occurs only if the injection is given repeatedly ( Generally done by Quacks !!) so it's quite Rare !!

Doctor What about the Cost?

The Injection costs are from Rs 100 to Rs 500 (Various Brands are there in the market) plus logistic costs like bandages, and syringes!! Overall, you may expect it to be somewhere around Rs 600 to Rs 1000/- (Depending on the Hospital/ Center as well as composition of Drug Used )

                      Gel or Hyaluronic Acid:  

Your Knee joint has a special lubricant or gel or hyaluronic acid that makes movement easier. Now with age, this lubricant dries up causing knee pain and discomfort.

Thanks to the advancement of Medical Science, now we can put this Gelly back inside your knees!! But since it's artificially prepared and imported, it's Quite Costly!

How does it Work?

 The Gel or hyaluronic acid acts as a lubricant inside the knee joint and prevents damage to the cartilage. It also decreases pain by removing the pain-producing substances inside the knee joint.

Hyaluronic acid is Normally present in your joint, produced by cartilage inside the knee but with age, your cartilage stops producing these substances causing the knee to dry up and causing friction in the joints as you use them.

How Long will it work?

Now, this is a tricky question, as no one can exactly answer how long it will work. If we look into statistics, we generally expect 70-80 percent of patients to have good pain relief and if they exercise properly, they may not need another Injection. In 10% of Patients' yearly Injections (or twice a year) injections may be required for 3 consecutive years but unfortunately in another 5 to 10% of patients, it does not Work at all.

And it's quite difficult to say in which category a patient will fall but the more the earlier this injection is given the better the chances that it will work. 

There is a grading of Knee osteoarthritis, and in Grades 2 and 3 any injection works the Best.

So, Doctor do we need to Repeat the Injection?

 In 10% of Patients' yearly Injections (or twice a year), injections may be required for 2-3 consecutive years.

Doctor, is it Painful? 

No, if it's given properly and by an experienced Doctor it will be much less painful than your Covid Vaccine!

Doctor, What about Side effects?

Side effects that generally we expect are a minor increase in pain and swelling in the joint.

If, not given in a Sterile environment risk of Infection is there.

In some preparations, people with an allergy to Egg are advised not to have this Injection with the risk of increased allergic reaction. 

Doctor, What is the Cost?

The cost is a bit in the higher range and depending on the Quality and composition of the medicine it ranges somewhere from Rs 15,000/- to Rs 20,000/- per Injection. ( Plus costs of other things like gloves , syringes adds up to it )

And  Doctor any special instructions after Injection?

Yes, Avoid Exercise for Two Days and Water contact over the injected area for the day.

Look for any Swelling or Redness over the area post Injection.

                      Platelet Rich Plasma(PRP)

This is quite an interesting treatment, where your own blood after preparation (i.e, Centrifugation) is injected inside your knees.

How does it Work?

Blood is formed of various cells, like RBCs, WBCs ( Remember Biology Class ?) and one of them is Platelets.

Now, this platelet has various growth factors, which when given in huge concentration in a joint help in regenerating the damaged joint or cartilage. 

 How Long will it work?

Since regeneration takes time so we don't expect immediate pain relief but over 4-6 weeks pain should decrease as the regeneration starts. 

It generally Lasts for 6-9 Months depending on your Knee condition at the time of Injection. 

But, it may last quite long if proper exercises are done during the Pain-Free Period.

So, Doctor do we need to Repeat the Injection?

yes, if the response is inadequate, your doctor may suggest frequent injections in two weeks intervals as needed.

Doctor, is it Painful? 

No, if it's given properly and by an experienced Doctor it will be much less painful than your Covid Vaccine!

Are There any Special things to follow after the Injection?

We generally advise avoiding exercise and excessive activity for the next TWO days! and Water Contact to the injection site for 24 hours !!

Doctor, What about Side effects?

Same as the other two Injections Mentioned above.

Doctor, What is the Cost?

 The cost depends on the type of machine used. The Cost may vary from Rs 1000/- to Rs 5000/- or even higher depending on the Center and type of Kit used.

And  Doctor any special instructions after Injection?

Avoid taking Pain Killers Post injection as it interferes with platelets. (Except, that is given by your doctor)

Rest Same as the Other Two Injections mentioned above.

Special Notes:

1. Injections are offered as a treatment modality only if medicines and exercises have not shown desired response.

2. Injections don't mean a Cure for the Disease !! Remember it is due to the aging of joints and no one can stop aging.

3. There are many other options like stem cell therapy but they are not so popular yet and hence not mentioned here.

4. This is the view of the Author, your treating doctor will be the best one to decide about your treatment guidelines.

5. Rates mentioned depends on various factors, so kindly talk to your doctors , Mentioned Rates are just for References !