HA Injections - PREVENTATIVE effect, or just pain relief?

Steroid injections, lubricants (eg Synvisc)
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QCassidy
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HA Injections - PREVENTATIVE effect, or just pain relief?

Post by QCassidy »

My ortho's opinion is that there is no preventative effect where HA would slow degeneration that has already started, but I'm a bit obsessive so spent several hours in the research. There's a ton out there on pain relief with strong evidence for relief in mild to moderate arthritis, less so for severe. Some reported extended time to knee replacement (1yr with placebo vs 3yr with HA), but that could just be because of pain relief rather than slowing degeneration.

For prevention, I found very little research at all. A couple studies did report a reduction or elimination of further cartilage thinning/damage after a 1yr followup. But the level of evidence seems weak. On an optimistic note, I didn't find anything saying that it DIDNT provide some protection. I just couldn't find much either way!

One interesting thing I read is that added HA is only in the joint for a few days before being absorbed by the body. So the common assumed effect from added lubrication and cushioning doesn't make sense to me. There are quite a few other things that it does, but they aren't sure which is the reason it works. Likely a combination of them.

I'd love to hear some personal anecdotes or direction to some research I may have missed.


My case: I am 34, 11 yrs post PCL tear, and have developed mild to moderate degeneration in medial compartment. A good candidate for HA I think. I can manage with minimal pain by reducing my running (begrudgingly), so if there is no preventative effect of HA then it's not worth the money. But if periodic injections can significantly slow the rate of degeneration then it is tempting.

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vickster
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Re: HA Injections - PREVENTATIVE effect, or just pain relief?

Post by vickster »

My experience is that it reduces inflammation and helps post op healing. Inflammation is a big contributor to cartilage degeneration. Post op, it has enabled me to get back to function and exercise more quickly, which is good for the joint.

There aren't any obvious downsides unless allergic obviously!

That said I now have grade 3-4 degeneration in all compartments (I first had HA in late 2010, only had lateral damage then, a big chunk off femur from a bike accident) and have had a fair few injections since. I have found the 3 shot courses better than the single shots. In more severe wear, my OS combines HA and steroid (clearly steroid best avoided if joint in mainly good condition)

Unfortunately, nothing available yet truly rebuilds hyaline cartilage reliably and for the long term.
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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Re: HA Injections - PREVENTATIVE effect, or just pain relief?

Post by QCassidy »

Good to know. I will likely have another surgery at some point so i'll keep that in mind.

The downside for me is cost. $1400 (US) for the one dose version. The speculation that repeated injections can slow degeneration caught my eye. But that's a lot to pay based on speculation.
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Re: HA Injections - PREVENTATIVE effect, or just pain relief?

Post by vickster »

Indeed, if it cost that, I'd have to consider it more strongly. How much is the 3 dose course?
If you don't have major symptoms, much better to avoid surgery!
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
QCassidy
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Re: HA Injections - PREVENTATIVE effect, or just pain relief?

Post by QCassidy »

The 3 dose is about the same. And I'll definitely avoid surgery if I can. But it's probably inevitable that i'll end up there again someday.
Dave33
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Re: HA Injections - PREVENTATIVE effect, or just pain relief?

Post by Dave33 »

I've had two rounds of this, and have had zero benefit. When I did some googling back in the day, I didn't find the literature to be all that convincing vs placebo. Maybe there's more recent studies that say otherwise.

Corticosteroids on the other hand, seem to have more measurable effect.
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