Injection therapy is an effective way of reducing pain and improving function for many conditions like osteoarthritis. For many years, cortisone was used in injections because of its powerful anti-inflammatory effects but are now used far more sparingly because of concerns about side effects. As an alternative, Hyaluronic Acid (HA), a naturally occurring substance found in normal joints and tissues, can be injected without any concerns of harmful side effects and this treatment has been shown reduce pain and stiffness and allow increased movement and activity. This is now used widely in helping to treat the older active population as well as in sports medicine where it is used among elite footballers, cricketers etc. The benefit from injection treatment is enhanced with exercise and your physiotherapist will ensure this is integrated carefully in order to achieve the best possible outcome.
Injection therapy can be beneficial for all synovial joints, including
There are some cases where the use of cortisone is helpful (e.g. calcific tendinitis, acute bursitis, tenosynovitis) but this will be considered carefully with you, your physio and your doctor. Your physio will liaise with your GP about this in order to obtain the necessary medicines.
Joints are like gears – they work best if they’re well lubricated. In a healthy joint, a thick substance called synovial fluid provides lubrication, allowing bones to glide against one another. Synovial fluid acts as a shock absorber, too. In people with osteoarthritis, a critical substance in synovial fluid known as hyaluronic acid breaks down. Loss of hyaluronic acid appears to contribute to joint pain and stiffness.
Hyaluronic Acid is quite expensive in the UK market and for that reason very few injections are administered on the NHS. It is frequently used in treating osteoarthritis in the USA and in Europe.
Hyaluronic acid injections are a treatment option that can be used when a patient is no longer able to control pain caused by osteoarthritis. This may be because they can’t take anti inflammatories, the pain relief they were taking is no longer effective or the patient wants to try and avoid surgery.
In 2006, a team led by Nicholas Bellamy, MD, of the University of Queensland in Brisbane, Australia, reviewed 76 studies examining the use of hyaluronic acid for treating knee osteoarthritis. The review, the largest and most comprehensive of its kind, found that pain levels in the average patient who receives these injections are reduced by 28 to 54 percent. That’s roughly what a patient might expect from taking non steroidal antiinflammtory drugs (such as ibuprofen or naproxen). Meanwhile, hyaluronic acid improved the ability to move about and perform daily activities by 9 to 32 percent.
The effects of hyaluronic acid can take up to about 5 weeks before you will feel the full benefit. According to Bellamy’s review (which was conducted on behalf of the Cochrane Collaboration, an international consortium that reviews scientific evidence for medical treatments.
Why is hyaluronic acid preferential to having a steroid injection?
Pain relief from corticosteroids diminishes markedly within a month or so. Overuse of corticosteroids can have a catabolic effect – that is, it could cause cartilage to break down and deteriorate further. The Cochrane review found that pain-relieving benefits of hyaluronic acid persist at peak levels for about three months.
Why is a steroid injection preferential to hyaluronic acid?
It provides significant pain relief within a few days where as hyaluronic acid could take up to 5 weeks. The Cochrane review reflects how the average individual responds to a therapy and showed about 30 percent of people who undergo hyaluronic acid injections become virtually pain free, and symptom relief may last up to two years.Some people don’t respond to hyaluronic acid and there is no precursor as to which patients it will work for and which it won’t. The good new is that 30% people are pain free following hyaluronic acid injections, 50% report better symptoms but not complete resolution and only 20% have no benefit at all. There are 5 brands available in the United States and lots of people ask which is the most effective. Clinical trials suggest that they all work the same. At Physiotherapy2fit we opt to use Ostenil as being one of the cheaper available on the market we are able to pass this cost saving onto our patients.
Are there any side effects to hyalorinc acid injections?
Some people experience pain and swelling at the injection site that fades within a few days.
Beyond the question of how well viscosupplements work lies another intriguing area of inquiry: How do they work? Hyaluronic acid may act as a lubricant and shock absorber, but “there’s more to it than that,” says Dr. Moskowitz. “Hyaluronic acid has a lot of other activities in the joint.” For example, research suggests that hyaluronic acid interfere with prostaglandins and cytokines, naturally occurring compounds that promote inflammation.What’s more, studies indicate that injecting supplemental hyaluronic acid may coax the joint into increasing its own production of this important substance, which may in turn help to preserve cartilage. “There’s a lot of data to suggest that it can slow the disease down,” says Dr. Moskowitz, a coauthor of the Osteoarthritis Research Society International recommendations on treating hip and knee osteoarthritis. “Hyaluronic acid is not a magic pill,” says Dr. Moskowitz. “But it has a definite role in the armamentarium for treating osteoarthritis of the knee.”
What is Ostenil®?
Ostenil® is a treatment for the symptoms of osteoarthritis and other joint and tendon pain. It can be used in the knee, shoulder or in any of the other joints in the body that are classified as ‘synovial’. Despite supporting scientific evidence it is not commonly used within the NHS due to its cost but has been used privately and within sports medicine for many years with great effect. It has similar benefits to corticosteroid injections but with less side effects.
How does it work?
Ostenil® is a solution containing hyaluronic acid (your joint’s natural lubricator). It is injected into the space in the joint that contains synovial fluid and works by restoring the normal balance between the breakdown and production of hyaluronic acid. This effect of Ostenil® means that it can decrease pain and stiffness and improve the other symptoms of osteoarthritis. It can also be used for Frozen shoulder and shoulder impingement to reduce pain and aid rehabilitation.
What can I expect if I decide to have treatment with Ostenil®?
If you decide to have treatment with Ostenil®, it will be injected directly into the joint affected by osteoarthritis. It may take a number of days to take effect but then symptoms can improve for up to 9 Months. Once the effects of the first injection wears off, you can, if you choose, have another.
Are there any side effects?
The hyaluronic acid in Ostenil® is very pure and is manufactured using a process called fermentation. It contains no animal proteins, which means that it is very unlikely to cause an allergic reaction. Ostenil® has been given to thousands of patients and has not been found to cause any serious side effects.
Q: What is a corticosteroid?
A: A medicine which can relieve swelling, stiffness and pain by reducing inflammation.
Q: Why don’t I just take anti-inflammatory pills?
A: You can, but the side effects of these are much more common and can cause stomach upsets and bleeding. These injections bypass the stomach and are much more effective.
Q: Are there any times I should not have an injection?
A: Yes, if you:
-Are hypersensitivity or allergy to any of the drugs used: risk of anaphylaxis
-Have sepsis – local or systemic infection
-Are reluctant to have the injection
-If you are under 18
-Had a recent fracture
-Have a prosthetic joint
Q: What are the possible side-effects?
A: These are very rare and your clinician will discuss them with you:
-Post injection flare
-Infection – if the area becomes hot, swollen and painful for more than 24 hours you should contact your clinician or doctor immediately
-Impaired diabetic control
Price- £250 administered by our consultant physio or Advanced Physio Practitioner