Intra-articular injections for managing knee osteoarthritis

Written by: Professor Paul Lee
Published: | Updated: 20/08/2019
Edited by: Bronwen Griffiths

Knee pain is a common ailment and source of discomfort for the UK’s population, related to the obesity epidemic, our ageing population and our increasingly sedentary lifestyles. Knee pain is often attributed to osteoarthritis, with eventual treatment being a total knee replacement (TKR). However, due to low levels of patient satisfaction with this procedure, as well as poor outcomes, leading orthopaedic surgeons like Professor Paul Lee are turning to intra-articular injections to provide their patients with temporary pain relief.

Whilst a knee replacement may be necessary eventually, injections can provide patients with better pain relief than other conservative measures, such as analgesics and lifestyle changes. Here Professor Lee reviews the different types of injections available.

Corticosteroids

These injections have been around the longest and are often used to reduce pain and inflammation in the knee joints. The benefit of injecting corticosteroids rather than taking them orally or intravenously is that the side-effects of weight gain and osteoporosis are better avoided. There are several different types of corticosteroids available to use, and currently there is no conclusive evidence about which can deliver the best results in terms of pain relief. Despite their pain-relieving abilities, some patients experience side-effects of knee cartilage damage, which ultimately results in worsened knee pain and usability. It is thought that such injections are best used on a short-term basis to avoid such complications.

Hyaluronic acid (HA)

HA is naturally occurring in joints and is involved in shock absorption, energy dissipation and lubrication of said joints. HA is also said to have an anti-inflammatory effect, which is beneficial to knees affected by osteoarthritis. Interestingly, such knees have been shown to be deficient in HA. Hence, regular injections of HA are thought to increase production of HA and help to improve knee pain and function. However, corticosteroids are thought to have better short-term outcomes, but HA injections work better in the long-term.

Platelet-rich plasma (PRP)

PRP injections have become increasingly popular in recent years. PRP is a blood product that is derived from the patient’s own blood and contains high levels of platelets. Platelets contain several growth factors which have benefits related to tissue repair. PRP injections are thought to reduce pain, improve knee function and consequently, the overall quality of life. However, the long-term efficacy is not proven for PRP injections.

Novel substances

Whilst corticosteroids, HA and PRP injections are the most used and well-researched in treating knee arthritis, there is a lot more room for research on future intra-articular injections for this condition. With the more recent insights gained on the inflammatory element of osteoarthritis, there is an opportunity to use this finding to find better, more effective treatments that alleviate knee pain and improve knee function.

The above treatments do provide pain relief for patients with knee osteoarthritis, however, this relief is short-term and no such injection has been shown to modify disease progression. Ultimately, even with such treatments, a total knee replacement will likely be needed for such patients when function and quality of life become severely affected.

Read more: osteoarthritis in young people

If you are suffering from knee osteoarthritis, make an appointment with an expert to discuss treatment options.

By Professor Paul Lee
Orthopaedic surgery

Professor Paul Lee is a consultant orthopaedic surgeon based in London and Grantham, Lincolnshire, specialising in hip replacement, knee surgery and knee cartilage replacement alongside revision hip replacement, meniscus surgery and anterior cruciate ligament (ACL) surgery. He privately practises at 108 Harley Street medical centre and as the director at MSK Doctors in Ancaster, Lincolnshire. His NHS base is United Lincolnshire Hospitals NHS Trust where he is a consultant sports and arthroplasty surgeon and the Director of Research.

Professor Lee is highly qualified, and received his MBBCh in Medicine from Cardiff University in 2005 and went on to receive an MSc in Sports Medicine - Muscle Performance and Recovery, from Cardiff Metropolitan University three years later. He then returned to Cardiff University to complete a PhD entitled 'Treatment of Muscle Injuries' in 2013. 

He regularly treats elite sports people, including treatment of muscle injuries in UK Premier League footballers, significantly reducing their recovery time, allowing them to return to playing sooner. 

Professor Lee, who is held in high esteem by his patients, offers various non-surgical orthopaedic techniques including micro artho-glycan knee, actovegin muscle injury and stem cell injection treatments alongside the Unloader One® knee brace. He also prides himself in his surgical skills in the S.P.A.I.R.E tendon-sparing total hip replacement, FT-MPFL Patella re-alignment and All-Inside ACL reconstruction surgeries. 
He has also combined surgery, technology, engineering to develop the Single Treatment Autologous Chondrocyte implantation (STACi) procedure. 

Further to his qualifications, Professor Lee also has various fellowships from respected institutions including the Royal College of Surgeons of Edinburgh (Tr & Orth), the European Board of Orthopaedics and Traumatology (FEBOT) and Orthopaedics Hospital in Oswestry. 

He is also a certified expert in the use of the Exeter hip system, which was developed after training on the Robin Ling Exeter Hip Replacement Fellowship in the Princess Elizabeth Orthopaedic Hospital in Exeter. He also did international fellowships in Germany and Australia. Other higher training saw Professor Lee become a certified member of the Faculty of Sports and Exercise Medicine (MFSEM).

Professor Lee is widely published in various peer-reviewed journals and is an active member of the British Hip Society (BHS), British Orthopaedic Sports Trauma and Arthroscopy Association (BOSTAA) and the British Orthopaedic Association (BOA) alongside the Biological Knee Society (BKS). He is internationally recognised at the ICRS teaching centre of excellence for his teaching in cartilage and joint preservation surgery. 

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