Knee Injection Options
KNEE INJECTION OPTIONS
We all see great deal of Osteoarthritis of the knee in our practices. I am currently in an Adult Reconstruction Practice that only treats arthritis of the knee and hip. Needless to say, I get to see my fair share of Knee Osteoarthritis. Not everyone presenting to our practice is a surgical candidate. Along with other conservative treatment measures (activity modification, physical therapy, OTC meds, NSAIDs, Genicular Blocks) we offer a multitude of injection options for our patients.
We offer “traditional” corticosteroid injections (which have been discussed on the forum previously) as well as slow-release corticosteroid injections (Zilretta). This slow-release corticosteroid injection is a Poly-lactic glycolic acid (PLGA) microsphere with Triamcinalone that is released slowly over 3 months. PLGA is essentially what Vicryl is composed of. We have recently had great success with these injections in our practice, and have not seen the spike in blood sugar that we were seeing with traditional corticosteroid injections.
We also offer a variety of the viscous injections. This includes the single dose injections as well as the multiple dose injections. We have gone away from the buy and bill model in our practice as we sustained a significant loss several years ago. We will currently order through a patient’s specialty pharmacy and obtain the viscous injection that way. Some patients have reported significant relief in the past with these injections, and would like to continue them.
My physician has also started to advertise “regenerative medicine” on his website. These range from Platelet-rich Plasma (PRP) injections to stem cell injections as well as laboratory derived mesenchymal cells mixed with viscous. These injections are all cash pay as insurances are not covering them at this time.
It is important to inform patients that Osteoarthritis of the knee is not a “curable” disease and that all of the above injection options are purely palliative in nature. I have found it very beneficial to have multiple options for patients when offering injections, and then allowing the patient to have “some say” in selecting their treatment.
In recent months, as mentioned previously, our best results have been obtained with the slow release corticosteroid injection. What do you use in your practice? What have you seen the best results with?