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Author Topic: Hyalauronic acid/steroid injections for arthritis  (Read 128 times)

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Offline Stelfox

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Hyalauronic acid/steroid injections for arthritis
« on: April 15, 2019, 04:21:29 PM »
Hi everyone,

I was hoping I could get some advise/experiences from a similar situation.

Iíve got grade 4 arthritis in my left knee from previous 3 knee ops which were:

1st op Oct 2006: Left knee ACL graft repair, small medial and lateral meniscus removed.

2nd op Nov 2009: Left knee 1cm micro fracture (MFX) carried out on lateral femoral condyle and some more lateral meniscus removed.

3rd op Sept 2011: left knee 2cm micro fracture (MFX) carried out on the same are as before


Iíve recently been getting flare ups and slight swelling and aches/ stiffness for about 4 months now but I did have this episode about 2 years ago.  Iíve just seen Doctor Unwin in Windsor knee clinic UK and he said he thinks itís just a flare up. The pain is bareable but canít stop thinking about the slight ache and pain Iíve always got. The  discomfort ache gets worse, especially when Iím at work and Iíve walkedabout 6km. His suggested hyalauronic acid injections and steroid injections, but I really donít know if I should go for it or Iíve have to come to terms that I will have to live with pain.

Any suggestions or experiences would really be appreciated.

Thank you
Gareth

Offline Vickster

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Re: Hyalauronic acid/steroid injections for arthritis
« Reply #1 on: April 15, 2019, 05:33:27 PM »
How old are you? Are you a candidate for a partial or total replacement or are the injections to buy time?
Is your alignment correctable by osteotomy? Or unloader brace, Definitely worth investigating a custom brace given the amount of walking you have to do at work (assuming you can't change your job?)

It's certainly worth having the injections as you have nothing really to lose (assuming you're not allergic to the ingredients). Do you take an anti inflammatory and pain meds which aren't effective? Do you ice/heat/stretch at the end of each day?

My own OS is using a cocktail mixture of HA and steroid in younger arthritic patients with swelling and pain not yet needing a replacement (I might myself be a candidate if my recent arthroscopy doesn't have enough effect). I've had a number of HA injections over the years quite successfully
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Stelfox

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Re: Hyalauronic acid/steroid injections for arthritis
« Reply #2 on: April 15, 2019, 06:31:33 PM »
Hi Vickster,

Thank you for the quick reply. Iím 31 years old and apparently my alignment itís ok, knee replacement has been talk about only when Iím about 60 if I make it. But yes I do ice at the end of everyday and I stretch every morning and evening. I take every supplement you can think of and I donít take any pain killers, Iíve always been against them, but I need to change what Iím doing at the moment cause itís exhausting thinking and feeling the ache/pain every second of the day.

Thanks again for your quick reply!

Offline Vickster

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Re: Hyalauronic acid/steroid injections for arthritis
« Reply #3 on: April 15, 2019, 06:59:42 PM »
Why are you against pain meds if they help?
Iím always told to use heat for stiffness and muscle tightness. I have some arthritis in multiple joints.
Unfortunately, steroid will only give temporary relief. HA might help for longer but itís more for mild to moderate arthritis.

How are your leg muscles, if you have tightness, that can make the arthritic pain worse. Tried sports massage?

Are you a candidate for cartilage repair (more advanced options than mfx or resurfacing) or is the arthritis too widespread? One compartment or two or three?

See how it goes with the injections. If continue to get worse, seek out a surgeon who specialises in young arthritic knees (might need to go private).
Did you see a surgeon (Mr) or a sports doc or rheumatologist (Dr)?
If the former, is he the one saying no replacement before 60?  Was this NHS or private?
« Last Edit: April 15, 2019, 07:05:55 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Stelfox

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Re: Hyalauronic acid/steroid injections for arthritis
« Reply #4 on: April 16, 2019, 08:10:32 AM »
Thank you for your advise, itís given me some questions to ask.
Dr unwin is a orthopaedic knee surgeon, and itís through a private clinic. we have briefly spoke about cartilage replacement but apparently my knee is not a good candidate for it, but I will be seeing him on Thursday, and will ask how wide spread my arthritis is as Iíve just had an MRI and X-ray taken just so he could confirm what he thinks already.. I will try the injections and painkillers and see how that goes. I would say my muscles are pretty flexible as I stretch in the morning and afternoon but my left leg has far smaller muscles than my good right knee, but find it hard to build muscle when it hurts sometimes. Have you got any good recommendations of specialist in young arthritic knees?

Offline Vickster

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Re: Hyalauronic acid/steroid injections for arthritis
« Reply #5 on: April 16, 2019, 08:33:11 AM »
Ah, heís a surgeon. Theyíre called Mr in the U.K. for an obscure historical reason! His profile says he doesnít do replacements and seems to specialise more in paediatrics? And often refers people on if needed so you could ask his opinion?

https://www.spirehealthcare.com/consultant-profiles/mr-andrew-unwin-c3284188/

If I were a candidate for partial knee resurfacing, Iíd consult David Barrett in Southampton

http://www.professordavidbarrett.co.uk/

http://www.uhs.nhs.uk/AboutTheTrust/Newsandpublications/Latestnews/2012/Surgeonshalverecoverytimewithpioneeringkneerepairoperation.aspx

If you want to avoid surgery and need an assessment and rehab programme, seeing Clare Robertson might be helpful (about £200 for a thorough assessment)
http://clairepatella.com/about-claire/

This might be useful for some research
https://www.kneeguru.co.uk/KNEEnotes/ebooks/knee-arthritis-interventions-when-you-are-too-young-total-knee-replacement
« Last Edit: April 16, 2019, 08:53:23 AM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Stelfox

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Re: Hyalauronic acid/steroid injections for arthritis
« Reply #6 on: April 17, 2019, 07:00:00 AM »
Thatís great info, thank you. Itís reaffirmed my thoughts and good to know about Clare Robertson.
 I will be asking my questions to Mr Unwin tomorrow and I will give an update incase anybody is in a similar situation and comes across this thread.

Thanks again Vickster!

Offline Stelfox

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Re: Hyalauronic acid/steroid injections for arthritis
« Reply #7 on: April 21, 2019, 01:21:28 PM »
Just wanted to give an update to my situation incase anybody else comes across this situation.

Iíve just seen Mr Unwin, and Iíve been told after my recent MRI scan and X-ray that my knee hasnít deteriorated since my last Op in 2011. Which is a good news. Iíve been told itís most likely a flare up due to overuse when I over did it in jan, (12 weeks ago) I have good days and bad days but I think in general the flare up is reducing. Iím not going to take any injections as Iíve been told that they would only really be effective for mild to moderate arthritis. But if it does deteriorate anymore I will be trying them out. Hope this info/experience might benefit someone else.

Thanks again for your help Vickster.

Offline Vickster

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Re: Hyalauronic acid/steroid injections for arthritis
« Reply #8 on: April 21, 2019, 01:25:19 PM »
Good news  :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up















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