Needles, Needles, Needles
In the realm of knees and needles, several options are available to help alleviate the discomfort that comes from inflammation often caused by arthritis. It is important that you, as a patient, know and agree to the treatment that your physician recommends. It is equally important to have an understanding of what the treatment is trying to accomplish and to be an active part of your treatment plan.
The most commonly used injection to treat knee arthritis is an intra-articular cortisone injection. Cortisone is an anti-inflammatory medication. The medication is drawn into a syringe along with a numbing agent similar to what your dentist uses to numb your mouth. Your physician will determine the easiest injection site that allows him to successfully guide the needle into the joint. The joint is a hollow space, so as long as the needle penetrates the joint, the medication will flow throughout the area. You can expect some same-day relief due to the numbing medication; however, the cortisone itself could take up to a couple weeks to provide relief because it needs time to act upon the inflammation. Once the inflammation is diminished, you should feel relief in and around that joint. The goal of cortisone is to provide at least six months of relief, but some patients experience relief for even longer. Cortisone injections can only be administered every 4-6 months or as deemed appropriate by your physician.
A different type of injection exists to help alleviate the pain of arthritis: hyaluronic acid. This derivative is used to produce a lubricant-style injection. The process of injecting the fluid is similar to that of a cortisone injection. This fluid has a thicker consistency than cortisone. It is more of a gel-like substance that is intended to decrease friction in the joint and allow it to move more fluidly, which in turn allows the joint to produce less pain-inducing inflammation. This particular injection requires insurance approval as it is significantly more expensive than a cortisone injection. If you doctor believes it is an appropriate treatment for you, he will submit a request to your insurance company for approval. Your insurance company’s response includes which of the numerous brands, if any, they cover. A handful of brands exist, and some of them carry one-injection options and multi-injection options. The one-injection option is a larger syringe containing the entirety of the medication. The multi-syringe injections require multiple visits to our office because only a portion of the medication is injected at a time, but some patients state that these smaller injections are more comfortable. Patients who do not tolerate the needle poke portion of the procedure prefer to have all of the medication injected at one time. Ultimately, it is up to the insurance company, but we do try to help patients get the style of injection that is best for them.
A third treatment that can be accomplished via a needle is a knee joint aspiration. Aspiration, or the removal of fluid, can help provide some immediate relief because excess fluid in a joint can cause significant discomfort. If you have a largely swollen joint, your physician may decide to aspirate the fluid. He will insert a needle on an empty syringe into the joint to draw the fluid out. Upon removing the problematic fluid, he may then recommend a cortisone injection as well to help prevent the fluid from returning. If you present to clinic for one of your lubricant injections with a swollen knee, your physician may first want to aspirate the fluid so the medication has a better chance of being effective. If the aspirated fluid looks concerning to your doctor, he may
recommend that labs be run on the fluid to look for infection, gout, or other inflammatory conditions. All of these treatments can be used in conjunction with one another. For example, if your cortisone injection only provided relief for a couple of months, your physician may recommend the lubricant injection, but that doesn’t mean that you can never have cortisone again. Your doctor will help guide you through the available treatments and establish a plan of care.
Here at OAW, we recognize that needles are no one’s favorite things. Unfortunately, they do play a significant role in the orthopaedic treatment of joints. We do take steps to help minimize the anxiety and discomfort the procedure causes. A lot of our physicians use a freeze spray called ethyl chloride to help numb the sensation of a needle poke. Sometimes, the doctor may use a local anesthetic to numb the area while the injection or aspiration is happening. Sometimes a little verbal reassurance or small talk is all the distraction needed to help a patient calmly through a little discomfort in the hopes of feeling a whole lot of relief!