Joint Injections for Arthritis Pain Relief
Minimally Invasive Injections to Reduce Joint Inflammation and Alleviate Pain
Managing arthritis typically requires a comprehensive approach that combines multiple treatment methods. These may include lifestyle adjustments such as a balanced diet, regular exercise, and the use of cold and heat therapy. Physiotherapy, oral medications, topical treatments, and joint injections may also be recommended to help manage pain and inflammation in affected joints.
In the following sections, we will explore different injectable treatments that may help relieve arthritic pain and improve mobility for those suffering from arthritis.
CORTICOSTEROID (CORTISONE) INJECTIONS
Ultrasound-guided cortisone injections involve administering a corticosteroid medication directly into the affected joint or surrounding tissues to help alleviate inflammation and reduce pain. Cortisone, a synthetic version of the body’s natural cortisol hormone, has potent anti-inflammatory properties. When injected into a joint or inflamed area, cortisone can help suppress the immune response and decrease inflammation associated with conditions such as bursitis, tendonitis, or arthritis.
- Benefits and Considerations: Corticosteroid injections can provide quick relief from pain and inflammation, usually lasting about a month. An extended-release version may provide relief for up to three months for knee osteoarthritis. Repeated injections can, however, cause cartilage deterioration and weaken surrounding tendons and ligaments. Temporary pain flare-ups can also occur in the injected joint but should subside within 48 hours.
- Ideal Candidates: A cortisone injection is usually suitable for individuals with severe joint pain or inflammation requiring rapid, temporary relief. The effectiveness and duration of pain relief can vary from person to person, and individuals need to follow Dr Liddell’s or their healthcare provider’s guidance regarding the frequency and timing of cortisone injections for optimal management of their condition. While cortisone injections can significantly relieve pain and inflammation, they are often used as a short-term solution and may be part of a broader treatment plan that includes physiotherapy, rest, and lifestyle modifications.
- Commonly Treated Joints: Ankle, elbow, hip, knee, shoulder, and small joints of the hands, feet, spine, and wrists. Zilretta is specifically for knee use.
WHAT TO EXPECT DURING A CORTISONE INJECTION
The Cortisone injection is typically performed by a qualified healthcare professional, such as a rheumatologist or orthopaedic surgeon. Dr Liddell usually refers his patients to an experienced radiologist to perform the procedure using ultrasound guidance for precision.
- Ultrasound Scanning – The radiologist uses ultrasound scanning to locate the exact area for the injection and determine the best approach. This ensures the cortisone is delivered precisely where it is needed.
- Aseptic Conditions – The procedure is conducted under aseptic conditions to prevent infection. The skin over the injection site is cleaned thoroughly.
- Injection – The radiologist uses a thin needle to inject the cortisone directly into the target area. The use of ultrasound guidance helps position the needle accurately.
- Duration: The procedure typically takes about 30 minutes, but patients should allocate around 1 hour from start to finish to account for preparation and post-procedure care.
- Bleeding: Minimal bleeding is expected. A small dressing is applied to the injection site after the needle is removed.
- Immediate Comfort: Most patients feel comfortable immediately after the injection and can leave the clinic shortly after the procedure.
- Resuming Activities: Patients may resume light activities as soon as they feel comfortable, which is usually immediately post-procedure. Strenuous activities however, should be avoided for a few days to ensure optimal healing.
THE COST OF A CORTISONE INJECTION IN PERTH
If you have a referral from your General Practitioner (GP) or from Dr Liddell for a joint-related cortisone injection performed at a radiology clinic, the total cost is approximately $365. This includes the procedure and the use of ultrasound guidance. With a Medicare rebate of $125, the out-of-pocket expense for patients is around $240.
For more detailed information on costs and to discuss your specific needs, please schedule a consultation with Dr Liddell at the Perth Orthopaedic & Sports Medicine practice in West Perth.
HYALURONIC ACID (CINGAL) INJECTIONS VISCOSUPPLEMENTATION
Hyaluronic acid is a naturally occurring substance in joint fluid that helps lubricate and cushion the joint. Viscosupplementation is a procedure where hyaluronic acid (HA) is injected into the synovial fluid surrounding the knee joint to treat osteoarthritis pain. HA acts as a joint lubricant, providing pain relief and increased mobility.
For patients suffering from arthritis, an injection of Cingal, a formulation that combines hyaluronic acid and a corticosteroid, can help replenish this lost lubricant. The hyaluronic acid component improves joint lubrication and potentially reduces pain and stiffness associated with osteoarthritis, while the corticosteroid provides fast-acting anti-inflammatory relief.
- Benefits and Considerations: Hyaluronic acid injections may provide relief from pain and improve joint function, with effects lasting from six months to a year for many patients. The injections are particularly effective for individuals with mild to moderate osteoarthritis. However, results can vary, and some patients may not experience significant improvement. Common side effects include pain, swelling, heat, redness, and fluid build-up around the injection site.
- Ideal Candidates: Hyaluronic acid + corticosteroid is suitable for individuals with knee osteoarthritis who have not responded to other non-surgical treatments such as pain medications, physiotherapy, or corticosteroid injections. It can also be part of a broader treatment plan that includes lifestyle modifications and physiotherapy exercises.
- Commonly Treated Joints: The knee is the most common joint treated with hyaluronic acid injections. Treatment can be administered in both knees simultaneously or, at different times, depending on individual requirements. Hyaluronic acid injections can also be used off-label for shoulder, hip, and ankle arthritis pain.
WHAT TO EXPECT DURING THE HYALURONIC ACID INJECTION PROCEDURE
Dr Liddell will numb the area around the joint with a local anaesthetic and ultrasound guidance may be used (but not always) to ensure accurate needle placement.
The hyaluronic acid is injected directly into the joint. The procedure typically takes just a few minutes, but you should allocate around 30 minutes from start to finish.
After the injection, you may experience mild discomfort. Ice packs and analgesics can help alleviate this. Avoid strenuous activities for 48 hours to a week.
Although individual responses vary, you should start to experience pain relief around one month after the injection, with effects potentially lasting around six months.
THE COST OF A HYALURONIC ACID (CINGAL) INJECTION IN PERTH
If you have a referral from your General Practitioner (GP), the cost of a Cingal injection, administered by Dr Antony Liddell, is approximately $690 per injection, with a Medicare rebate available.
PROLOTHERAPY (HYPEROSMOLAR DEXTROSE) INJECTIONS
Prolotherapy (short for ‘proliferation therapy’) is a form of therapy that aims to stimulate the proliferation (growth) and repair of injured tissue. It is designed to strengthen ligaments and tendons by addressing the root cause of pain in and around the joints. This therapy involves injecting a solution, typically a sugar-based irritant, into precise points where ligaments or tendons attach to the bone or into the joint capsule. The injection triggers a localised healing response, leading to the strengthening, tightening, and healing of these tissues.
- Benefits and Considerations: Prolotherapy can stimulate the healing of joint surfaces, which is particularly beneficial for individuals under 40 whose joint pain is often caused by tendon or ligament laxity. For those over 40, joint degeneration becomes a significant contributor to pain, and prolotherapy may help promote tissue repair. While prolotherapy has been shown to relieve pain and improve function, its long-term safety and efficacy are still subjects of ongoing research. Some potential side effects include temporary pain at the injection site and swelling. It is important to discuss these risks with Dr Liddell to determine if prolotherapy is suitable for your specific condition.
- Ideal Candidates: Prolotherapy may be suitable for individuals with chronic joint pain, especially those who have not found relief through other treatments such as physiotherapy or medications. It can be particularly effective for treating pain resulting from ligament or tendon laxity and may also aid in addressing pain related to joint degeneration in older adults.
Whilst Dr Liddell does not offer Prolotherapy in his practice, it can be effective for various osteoarthritic joints, with the best results often seen in the knee, lower back, and fingers.
PLATELET-RICH PLASMA (PRP) THERAPY
Platelet-Rich Plasma (PRP) therapy uses a concentration of your own platelets to accelerate the healing of injured tendons, ligaments, muscles, and joints. By spinning a blood sample in a centrifuge, the platelets are separated from other blood components, creating a plasma rich in growth factors. These growth factors can enhance the body’s natural healing processes when injected into the damaged area.
- Benefits and Considerations: PRP injections have been shown to help with the healing of chronic tendon injuries, such as tennis elbow and jumper’s knee, as well as osteoarthritis of the knee. The high concentration of growth factors in PRP can stimulate and accelerate tissue repair, potentially reducing pain and improving function over several weeks to months. The effectiveness of PRP however, can vary, and it may not provide immediate relief. Some patients may also require multiple injections spaced weeks apart for it to be effective.
- Commonly Treated Joints: Platelet-Rich Plasma (PRP) therapy is most commonly studied for use in the knee, particularly for osteoarthritis. However, it may also be used in other joints and soft tissue areas. Commonly treated conditions include chronic tendon injuries such as tennis elbow and Achilles tendonitis, as well as muscle and ligament injuries.
COST OF PLATELET-RICH PLASMA (PRP) THERAPY
In Australia, the cost of Platelet-Rich Plasma (PRP) therapy typically ranges from $400 to $700 per session. While Dr Liddell does not offer PRP therapy as a treatment option for his patients, he is happy to discuss alternative treatments and provide guidance on the best available options for managing your condition.
AUTOLOGOUS CONDITIONED SERUM (ACS)
Autologous Conditioned Serum (ACS), also known as Orthokine therapy, is a regenerative treatment developed to address conditions such as osteoarthritis and musculoskeletal pain. This therapy involves using your own blood to produce a serum enriched with anti-inflammatory cytokines, particularly the interleukin-1 receptor antagonist (IL-1Ra), which helps inhibit the inflammatory processes contributing to joint pain and tissue degradation.
- Benefits and Considerations: ACS injections have been shown to reduce inflammation, alleviate pain, and protect cartilage from further degradation. This treatment may be particularly beneficial for patients with osteoarthritis, tendinopathies, and other chronic joint issues. While ACS is considered safe and effective, the treatment does not guarantee immediate results, and multiple sessions may be required for optimal benefits.
- Commonly Treated Conditions: Autologous Conditioned Serum (ACS) is commonly used to help manage joint and soft tissue conditions by reducing inflammation and promoting healing. Conditions often treated with ACS include osteoarthritis (particularly of the knee and hip), tendon and ligament injuries, and post-surgical recovery, such as following ACL reconstruction.
STEM CELL THERAPY
Stem cell therapy is a regenerative treatment designed to repair damaged tissues by reducing inflammation and modulating the immune system. Stem cells, particularly mesenchymal stem cells (MSCs), can differentiate into various cell types, aiding in the repair of damaged tissues. In Australia, stem cell therapy is still being explored for conditions like osteoarthritis, tendon injuries, and other musculoskeletal disorders.
- Benefits and Considerations: Stem cell injections can potentially reduce inflammation, alleviate pain, and promote tissue regeneration. These benefits make it a promising treatment for chronic conditions such as osteoarthritis and tendon injuries. The effectiveness of stem cell therapy can vary however, and high-quality evidence supporting its widespread use is still being gathered through ongoing clinical trials. Patients should discuss the potential benefits and risks with their General Practitioner (GP) to determine if stem cell therapy is appropriate for their condition.
- Ideal Candidates: Stem cell therapy is suitable for individuals with chronic musculoskeletal injuries or osteoarthritis who have not responded well to traditional treatments. It is particularly considered for patients looking for alternatives to surgery or those who have not found relief with other non-surgical treatments.
- Commonly Treated Conditions:
- Osteoarthritis (especially knee and hip)
- Tendon injuries (e.g., Achilles tendonitis, rotator cuff injuries)
- Ligament injuries
- Cartilage defects
In Australia, the cost of stem cell therapy can vary widely but generally ranges from $3,000 to $7,000 per session. While Dr Liddell does not offer Stem Cell Therapy as a treatment option for his patients, he is happy to discuss alternative treatments and provide guidance on the best available options for managing your condition.
For more information or to discuss which treatment might be best for you, please schedule an appointment with Dr Antony Liddell.