What is the role of injections in managing knee arthritis?

Knee arthritis causes pain, swelling, stiffness, and decreased mobility in the knee joint, impairing daily activities and reducing the quality of life for affected individuals. One option used to alleviate pain from the condition is knee injections. Leading consultant trauma and orthopaedic surgeon Mr Muhammad Adeel Akhtar examines the role of injections in managing the condition.

Do any injection options for knee arthritis offer long-term benefits like slowing disease progression or promoting cartilage repair?

This topic is debatable, as there is no consensus in the literature. Additionally, the efficacy varies depending on the type of injection. Steroid injections are more potent, but can affect the cartilage and their effect is short-acting, from weeks to months, as compared to hyaluronic (gel injection) which can take longer to be effective but potentially its effect is longer acting.

Biological injections like platelet-rich plasma (PRP), and stem cell injections have the potential to slow disease progression and promote cartilage repair. However, determining the optimal dosage for individual patients remains uncertain, leading to controversy regarding their effectiveness in the literature.

Which type of injection is most effective for different stages and severities of knee osteoarthritis, and how do individual factors like age and activity level influence this choice?

Hyaluronic acid (gel injection) is more suitable for earlier stages of knee osteoarthritis and is preferable in younger patients, particularly favoured among younger patients. Conversely, steroid injections are considered more beneficial for advanced stages of arthritis and in older individuals. Biological injections have potential benefits in different stages of the disease and are recommended for active patients regardless of their age

What are the safety considerations and potential side effects associated with different injection treatments for knee arthritis, and how can these be minimised?

The primary risk surrounding injections is that of infections. Fortunately, the likelihood of infections occurring is extremely rare.  Additionally, there exists a small risk of experiencing a flare-up following any type of injection. It should be noted that the benefits of injections may diminish over time, potentially requiring repetition based on individual patient discussions. Adhering to aseptic techniques during these procedures minimises the risk of infection, and employing image guidance can enhance the accuracy of injection delivery, particularly in cases where large soft tissue surrounds the joints, rather than relying solely on anatomical landmarks.

With new and emerging injection options like stem cells and platelet-rich plasma gaining traction, what is the current evidence for their effectiveness and role in managing knee arthritis compared to established options?

Despite growing proof of their effectiveness, there is a lack of high-quality randomised controlled trials to examine different patient groups with varying disease severity levels.

What are the cost implications of different injection therapies for knee arthritis, and how do they compare to other non-surgical and surgical management options available to patients?

There is little evidence available regarding the cost-effectiveness of different types of injections. Steroids are the cheapest, therefore they are the most commonly used, followed by hyaluronic acid injections, PRP and stem cells. While injections generally remain more economical than surgical interventions, certain newer gel and stem cell injections, if repeated, can match the cost of an operation. Specialists should present patients with all available options, along with a discussion about the likelihood of success of different treatment options before agreeing to any treatment.

If you would like to learn more about injections for knee arthritis and would like to book a consultation with Mr Akthar, do not hesitate to do so by visiting his Top Doctors profile today