Gel Injections? Tell me what you can.

[mendogal]

Thank you for the update.

 

[Me2]

Updating once again..... My knee pain has really increased after the second injection. The area seems so tender and painful under the whole "knee cap" area. I reviewed with the doctor before the third injection but decided to just go with it since I was two injections in already. That was Friday morning. Oh, geez, so painful since. Walking, sleeping, rising to standing. I'm not a pain wimp and usually don't let pain bother me but this is pretty bad. Hoping for some reassurances from BoneSmartees.

 

[mendogal]

Oh my. Well, it sounds like the knee pain increased after the second injection AND never really went away, is that right?
Fingers crossed the pain diminishes after this third injection.

Are you using acetaminophen as a pain reliever? If there's no medical reason to avoid it, a safe dosage is two extra strength (= 1,000 mg) every six to eight hours.
If you are taking other meds that include acetaminophen as an ingredient? It's important to not go over 4,000 mg total in 24 hours.

If the physician didn't specify, you might call Monday to ask whether ice or heat is ok to relieve the pain.

 

[Me2]

Correct. Pain got worse with second and, now, even worse with third. Hoping, with great pain, comes improvement. lol. Yes, he did specify ice the usual 20 minutes on, 20 minutes off and acetaminophin.

 

[Linda1]

I had several sets of the gel shots over the years. They helped a great deal for several years, but then the time frame that they helped kept getting shorter. The knee would be more painful the first week after each shot and then slowly feel better.

 

[ropeyknees99]

I've had bilateral PRP+hyaluronic acid in February and four months later Arthrosamid (hyaluronic acid + polymer, which binds to the synovium) injections.

The PRP injection was horrible due to the amount of fluid injected, but absolutely no pain or swelling after other than my joints being full of hyaluronic acid which subsided after a few days. I think the effect was very small and I don't know whether the small improvement I saw was the change in season (winter to spring) or a general improvement due to giving up high impact exercise a few months prior.

Had Arthrosamid two months ago. Less fluid injected but it was done on the lateral side where I have no cartilage so there was some swelling for a few weeks. I've seen a very small improvement from this, apparently it can take some months to work, although I'm beginning to doubt there will be anything other than a marginal improvement. Seeing the doctor in six weeks to see if I need a top up, apparently the manufacturer provides this for free in certain cases (don't believe healthcare in the UK is free, I had to pay for this injection as it isn't offered by our "free" health care system). Crossing fingers for more of an affect, other people have seen a very large improvement.

 

[ropeyknees99]

Hello. I'm sorry you're in knee trouble land now.

Bottom line is that once we are bone on bone there is nothing for the gel to actually DO of benefit.

Once we are bone on bone AND having pain interfere with function, the sooner we get a replacement the better. Why?
1) you want to be in the best condition possible before surgery, because you will, short term, lose muscle mass and stamina. You can get "pre hab" PT, as I did, to develop a simple knee-friendly home routine to be in as good shape as possible. I was limited by knee pain to straight leg raises and glute clamshells, but it helped a lot!
2) the longer you wait, the more your entire structure will mal-adapt, from further tearing up of the menisci to the muscles, tendons, and ligaments from foot through pelvis either contracting and shortening or stretching and becoming lax. This is bad for the whole body and makes recovery more complicated.

I'm inclined to agree but the treatment I have had, Arthrosamid apparently does work even with bone on bone because it has a polymer which binds to the synovium.

I told the doctor, six weeks after the injection that I can now feel my patella rubbing against the bone on the lateral side of both knees. If anything it's more pronounced after the injection than before. There is no pain, it's just a bit stiff. The doctor said the injection interferes with the inflammatory response more than anything.

One of the main issues I have is that my patellas don't track properly but my knees really complain when I do the physio exercises that would strengthen the muscles that control the tracking. If the injection can break the vicious cycle that this creates perhaps it will have been worth the cost and delay the need for a replacement, although I'm quite dubious at the moment.

 

[mendogal]

@ropeyknees99 I was responding to a specific question about hylauronic acid.

 

[Rustwheel53]

The gel injections worked for 3 weeks, then stopped completely. I was even able to play a little tennis ! It was disappointing. Trying to hold off on TKR till December.

 

[Me2]

Hey everyone! I never did update. So, three gel injections, each one progressively more painful. Waited the 4-6 weeks for improvement. And.... minimal if anything. I'm still thinking a tad worse. And..... because I was being stupid and walking funny and limping around and favoring the left gel knee, I twisted my right knee. Finally I got in to see orthopedic doctor, and he said, of course, give it another couple of weeks and do gentle exercises with right knee and stop gimping around. Yes, gimping around will make both hurt more. So, I did decide no more gimping and trying to find time to do a little stationary bike. It has loosened up some. Going to try to be determined to do exercises and hope for the best. Appointment in early November.

 

[cabland]

I too tried the gel injection (but only 1 - monovisc) - no improvement. Even the steroid shots occasionally provided a little relief (albeit not very long lasting). It is very hit and miss for folks so I'm still glad I tried. However, I'm now a lot less interested in the other alternatives now like PRP, stems cells, magic elves, etc. - especially as most of those are not covered by insurance and have either no clinical evidence of efficacy or just very slightly better than hyaluronic acid.

 

[benne68]

Thanks for the update, @Me2. Sorry that the injections didn't help.

I had a somewhat similar experience: after a meniscus tear, I tried gel injections in both knees. One (the left) was a little better, the other showed no improvement so I met with a surgeon to discuss replacement. As I noted above, he advised me that, once your knee is bone-on-bone, the gel doesn't work because there is nothing for it to stimulate -- which is why it helped the left knee but not the right.

So, I scheduled my first TKR (righty). As I recovered, my left knee began to feel better as it didn't have to compensate for the other knee. Unfortunately, that only lasted for a year or so until that knee also reached bone-on-bone status and I had to have it replaced.

So, here I am with two new knees -- one is 10-months old, the other is 2+years old -- and I feel like a totally different person. No more arthritis pain. I can do what I want. Walk as much as I want. Climb stairs. Go hiking. Bike ride. Kayak. Travel.

Are you considering a TKR now?