Cortisone, Orthovisc, Hyalgen, Synvisc etc - what is the difference?

[Fyre-Faery]

Hello,

I've been working for 3 years with a physio on what has been diagnosed as a Mal-tracking problem with no success. After 3 surgeons who've diagnosed sub-laxation a rheum has suggested it's possibly actually one of two rare types of arthritis. And that the minor mal tracking problem may be masking something else. Anyway, he's offered to give me a cortisone injection to see if it helps.

Can anyone fill me in on the difference between Cortisone & the other injections I see people have tried, and what they are for?
Does anyone have any success stories with using them?
I must admit, I'm a bit scared. But I was an acrobat before this took me down and too young to loose my knees!

Best Wishes
Flame**)

[TwoBadKneesUSA]

Hi Flame,

Cortizone is a steroid anti-inflamatory medication.  Usually it's injected with a mild anesthetic (numbing medication).  Many people have great success with them.  I don't get much out of them, so don't use them.

The other injections, (Orthovisc, Hyalgen, Synvisc ) are viscosupplimentation.  Basically they inject a lubricant into the joint to help cushion it.  Again most people get great relief with this.  I only got partial temporary relief.  I tend to react strangely to medicines so I think I am more of the exception.

I hope you get good results from the injections.  I wll say when I got mine it did hurt, but not long.  The knee felt "full" and a bit strange.  You need to make sure you take it easy after ward.

Good luck to you.

Milly

[arkitect06]

I have had both types of injections and both made me sore the next day.  Good luck with the cortisone shot.  If they fill you up with a local anaesthesia like Lidocaine, you will walk out of there feeling good for a few hours afterwards!  Unfortunately, after that wears off, the soreness kicks in big time until the cortisone starts working.  I hope it works for you.  The cortisone only helped me for a week, but I have a very difficult situation.  Good luck!

Farrah

[Penny W]

Farrah the cortisone never did much for me.But I had the Synvisc injections for a few years they helped alot  in the beginning.The injection was very painful for me  but no side affects afterwards.I hope you get some relief.Take care

[irentat]

Hello,

I've been working for 3 years with a physio on what has been diagnosed as a Mal-tracking problem with no success. After 3 surgeons who've diagnosed sub-laxation a rheum has not suggested it's possibly actually one of two rare types of arthritis. Anyway, he's giving me a cortisone injections in a week in both the joint & fat pack, to see if it helps.

Can anyone fill me in on the difference between Cortisone & the other injections I see people have tried, and what they are for?
Does anyone have any success stories with using them?
I must admit, I'm a bit scared. But I was an acrobat before this took me down and too young to loose my knees!

Best Wishes
Flame**)

Flame,

It seems to me you are getting a shot to hide symptoms and not solve the problem.  To quote another source: "The term ‘Kneecap Maltracking’ is usually used when there is a definable or measurable structural abnormality of part (or several parts) of the kneecap stabilizing mechanisms."

What are you doing to SOLVE the issue?  Both injections mention do nothing to solve your problem.

Ben

[GJJ]

Hello,

Cortisone may help the pain but not fix the maltracking.  Take a look at your feet and alignment.  Any type of surgery such as lateral release and etc. won't help unless you are aligned right from head to toe.  Your gait is important.  Orthos don't talk to foot or chiro's.

I had numerous shot.  They don't hurt me.  They should use numbing solutions first if not, you need to find another doctor who has the experience.

HA brands differ.  I had them too.  Some hurt for a week, some for about 10 minutes and then some don't.  Euflexxa has been the best for me.  they differ in molecular makeup and other ingredients (chemical)  provided by the makers.  It takes a lot of research.

Before you issue becomes out of control, seek a podiatrist and chiropracter for total body alignment.

[TwoBadKneesUSA]

I think many of these posts make a good point.  You should be seeking someone to help you try to correct the problem not just cover it up.  If these things are being done to help the pain before a specific procedure, then they may not be a bad idea.  Just hoping it is not all you are being offered to correct your tracking issues.

[Fyre-Faery]

Lovely to get all of your feedback.

I have specially made orthotic inner soles. The surgeons said my hip alignment looks fine, and that the mal-tracking is minor and should be fixed with 3 to 4 months of physiotherapy. No luck there, I have been struggling with physio for 3 years but when my knees are really bad I can't even do the most basic exersises.
What other solutions to Maltracking have people tried? It would be fab to hear them.

My physio says lots of people have maltracking problems like mine with no pain at all, it may be that this diagnosis is stopping them from finding the real problem. He suggested I try a rheumatologist. The Rheum has suggested it may be one of two types of rare arthritis - reactive arthritis I think was one of them? Has anyone here been diagnosed with that? Or been treated with cortisone for an arthritic problem?

Thanks, I really appreciate all these suggestions
Flame
X

[Fyre-Faery]

And one more question - does it make the joint completely inflammation free so you can do any level of exercise you would like to without inflammation - or does it just take the edge off?

[TwoBadKneesUSA]

Hi Flame,

I've had cortizone for arthritis.  It only helped me for a few weeks at best.  It reduces inflammation, so it's possible that it will come back.   Lots of people get many months of relief from them though. 

One other thing: Just because "most people" with your kind of maltracking don't have pain, there must be others who are not "most people" that are in pain too.  You stated in your first post that you were an acrobat.  You have very likely pounded your knees right into pain.  If they did not track quite right to start with all the acrobatics probably started the progression of cartilage degeneration.  I am a former runner with almost no cartilage behind my kneecaps.  You have not had any injury have you?  It may eventually boil down to a scope to get a look at what is really going on inside.  I tried PT for months myself before the OS decided that he had to go in and look around.  That was 20 years ago, but same story you seem to be getting, "it'll all get better just do your PT".  A bunch of hooey if you ask me.  If 3 years has not helped then it's time to try something else.  It looks like 3 docs have said it's possible subluxion.  They could be right.  You don't have to have a major episode, lots of mini ones can cause as much damage.  I get little ones quite a bit, it's just a very sharp pain when I hit a step just right (mostly on stairs).  A bigger sublux feels like the knee is sliding sideways or that the upper leg is twisting one way and the lower is twisting another.  Usually only lasts a few seconds, but YOUCH!.

Have you had any x-rays or MRI scans or anything like that?

Let us know how you are doing.

Milly

[GJJ]

Hello,

Milly is right, get a x-ray and MRI by a reputable place that has up to date equipment and radiologist who know how to read them.  Your doctor is not a radiologist.  Try the Euflexxa (HA) first and if that does not work, try cortizone.  HA is for arthritis but the patella area is hard to treat.  They are still not sure how and why.  Try to avoid any surgeries if your young and hope to be active.  You really need to find a knee specialist.  They all say they are but not really.

GJJ

[Fyre-Faery]

Hello,

I have had X-rays and an MRI, there is no cartilage degeneration or mechanical damage. 3 Surgeons & a Podiatrist have looked at my alignment, which had only minor issues and have been fixed by Orthotic Inner soles. The whole problem came upon me very quickly, within a month from absolutrely fine to unable to walk, which is predominantly why I think they've been barking up the wrong tree for 3 years with the maltracking thing.

Anyway - I am so damn delighted, I visited my GP yesterday to discuss the Rheumatologists results. He had a long letter from him - and it all makes sense! It is most likely Reactive Arthritis (inflammation triggered by the bodies response to an infection, usually in the bowl or genitals, which can continue long after the infection as passed - much like urticaria, an unexplained rash on the skin that appears, annoys for months and disappears again).  The inflammation was so random, and often caused by an activity I'd done easily the week before, I had asked the surgeons I saw several times if it could be something like urticaria, which my husband had for several months, and they said no. The bastards.
So got a proper diagnosis now. It is definitely aggravated by the maltracking and certain exercises so I still need to work with a physio.

My GP also talked me through the cortisone injection, why it would be useful etc, and also mentioned I could try predisone first. Sounds interesting. Less direct, but if I have a bad reaction to it I'm not stuck with it in my system for 6 months.  Has anyone considered that instead or cortisone? 

[GJJ]

Good for you.

Predisone has side effects.  Ask you doctor or web search.





Good luck.

[TwoBadKneesUSA]

It's good that you have gotten a good diagnosis at last.  I hope they can come up with a treatment plan that will work out for you.  I personally don't get any relief from cortizone, but many people do.  Some have reactions, some very bad, but most do fine.  Prednisone is a steroid as well, but in tablet form.  It can cause side effects.  I found that for myself I had to drink a complete 8oz glass of water with each dose or I would have terriible heart palpitations.   Look at your options and decide which has the least possibility of severe side effects.  You of course do not have to take any medication if you don't want it.

Good luck.