Hyalauronic acid/steroid injections for arthritis

Steroid injections, lubricants (eg Synvisc)
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Stelfox
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Hyalauronic acid/steroid injections for arthritis

Post by Stelfox »

Hi everyone,

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

I've 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


I've 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. I've just seen Doctor Unwin in Windsor knee clinic UK and he said he thinks it's just a flare up. The pain is bareable but can't stop thinking about the slight ache and pain I've always got. The discomfort ache gets worse, especially when I'm at work and I've walkedabout 6km. His suggested hyalauronic acid injections and steroid injections, but I really don't know if I should go for it or I've have to come to terms that I will have to live with pain.

Any suggestions or experiences would really be appreciated.

Thank you
Gareth
2006: Left knee ACL graft repair, small medial and lateral meniscus removed.

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

2011: left knee 2cm micro fracture (MFX) carried out on the same area
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vickster
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Re: Hyalauronic acid/steroid injections for arthritis

Post by vickster »

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 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone
Stelfox
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Re: Hyalauronic acid/steroid injections for arthritis

Post by Stelfox »

Hi Vickster,

Thank you for the quick reply. I'm 31 years old and apparently my alignment it's ok, knee replacement has been talk about only when I'm 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 don't take any pain killers, I've always been against them, but I need to change what I'm doing at the moment cause it's exhausting thinking and feeling the ache/pain every second of the day.

Thanks again for your quick reply!
2006: Left knee ACL graft repair, small medial and lateral meniscus removed.

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

2011: left knee 2cm micro fracture (MFX) carried out on the same area
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vickster
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Re: Hyalauronic acid/steroid injections for arthritis

Post by vickster »

Why are you against pain meds if they help?
I'm 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 it's 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 edited by vickster on Mon Apr 15, 2019 7:05 pm, edited 1 time in total.
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone
Stelfox
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Re: Hyalauronic acid/steroid injections for arthritis

Post by Stelfox »

Thank you for your advise, it's given me some questions to ask.
Dr unwin is a orthopaedic knee surgeon, and it's 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 I've 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?
2006: Left knee ACL graft repair, small medial and lateral meniscus removed.

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

2011: left knee 2cm micro fracture (MFX) carried out on the same area
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vickster
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Re: Hyalauronic acid/steroid injections for arthritis

Post by vickster »

Ah, he's a surgeon. They're called Mr in the U.K. for an obscure historical reason! His profile says he doesn't 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/consult ... -c3284188/

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

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

http://www.uhs.nhs.uk/AboutTheTrust/New ... ation.aspx

If you want to avoid surgery and need an assessment and rehab programme, seeing Clare Robertson might be helpful (about xc2xa3200 for a thorough assessment)
http://clairepatella.com/about-claire/

This might be useful for some research
https://www.kneeguru.co.uk/KNEEnotes/eb ... eplacement
Last edited by vickster on Tue Apr 16, 2019 8:53 am, edited 1 time in total.
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone
Stelfox
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Posts: 51
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Re: Hyalauronic acid/steroid injections for arthritis

Post by Stelfox »

That's great info, thank you. It's 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!
2006: Left knee ACL graft repair, small medial and lateral meniscus removed.

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

2011: left knee 2cm micro fracture (MFX) carried out on the same area
Stelfox
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Posts: 51
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Re: Hyalauronic acid/steroid injections for arthritis

Post by Stelfox »

Just wanted to give an update to my situation incase anybody else comes across this situation.

I've just seen Mr Unwin, and I've been told after my recent MRI scan and X-ray that my knee hasn't deteriorated since my last Op in 2011. Which is a good news. I've been told it's 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. I'm not going to take any injections as I've 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.
2006: Left knee ACL graft repair, small medial and lateral meniscus removed.

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

2011: left knee 2cm micro fracture (MFX) carried out on the same area
User avatar
vickster
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Re: Hyalauronic acid/steroid injections for arthritis

Post by vickster »

Good news :)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone
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