injections for Grade 3 and 4?

Steroid injections, lubricants (eg Synvisc)
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injections for Grade 3 and 4?

Post by Petal »

I have a pretty wrecked right knee, had multiple surgeries on it and its not great.
At the moment I am having a bad flare up, walked too quickly a few weeks ago and it is swollen to hell , subluxating, semi catching and well it is a mess. I do ice, elevate etc and have prescription pain killers which are frankly not touching it at the moment.

Due to covid my GP is not doing steroid injections. I was able to secure a telephone appt for next week but little tricky to examine a knee on phone. I am getting a little desperate and although I really cannot afford it am eyeing up a local private clinic that is offering.

steroid injections- offer different strengths
hyaluronic acid injections
and something called Cingal pain relief injection treatment which is apparently a mix of both

I have had 2 steroid injections in the past- first one was super and lasted about 6 months, 2nd one did nothing at all. first one was from hospital- 2nd GP. did they use different strengths or was it technique or luck? I don't know.

I'll be straight- I cannot really afford this without cutting myself really short so can anyone advise which of these single injection treatments is most likely to calm my knee down? I am apparently grade 3 with mostly grade 4 arthritis. will any of them have an effect or am I better off getting a bottle of gin? lol I really cannot waste money on something that does not work but am desperate!
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vickster
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Re: injections for Grade 3 and 4?

Post by vickster »

I've had a number of rounds of hyaluronic acid injections on my left knee over the last 10 years.

The first few (I've had the single injections and rounds of three) when it was starting to wear seemed to help for a good year or 18 months (luckily private healthcare paid initially, not available on NHS at least in England, I'm assuming you're in the Uk?).
One thing I will say and my OS has seen it too that the 3 shot series (of Ostenil at least) is seemingly more effective than the single one (and would thus cost more presumably if needing to pay three times). The single one is also more painful due to higher viscosity.

Unfortunately, the last round a couple of years ago didn't make any difference and had the knee scoped a while after to clean up meniscus, clean out rubbish and micro fracture. Grade 3-4 in all compartments here!

I'd say if you've got severe arthritis as you indicate, you may or may not get any benefit for the outlay. If it works, it should last longer than a steroid injection, but about 50% seem to get no relief especially on the more severe side. My surgeon has mentioned Cingal to me too, but unfortunately I've got more torn meniscus causing locking and wear so I'm waiting for yet another scope (when they open up again).

It's a gamble in reality especially in a very worn knee. PRP is another option to at least hopefully relieve the inflammation, but even more costly.

I do find the 2.32% Voltaren gel pretty good actually, for the sake of a xc2xa310 tube, assuming no gastric issues, give it a try if you've not already.

Are you on a waiting list for a TKR?

Perhaps look at other medication options of your GP is willing (you don't say what you are taking)

Arthritis is a pain...literally (especially when on the younger side, I'm under 50)

All the best :)
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: injections for Grade 3 and 4?

Post by Petal »

Thank you. I will try the gel. thats one I haven't tried. tried other gels but not that one

I need to see what GP says Monday but I thinking I need refering back to orpho team as its really quite dramatically worse and I think maybe have torn a bit more or have fragments again. Its a few years since had an xray and yes I am in the UK

With the current time scales I know it will be a long wait. I can only afford one injection so need to think carefully what is most likely to give benefit if I do it. to be honest can't really afford one but desperate!

pain killers, currently on high strength paracetamol with codiene with ibuprofen. tried pregabalin in past but couldn't tolerate it and it didn't touch pain. also use tens machine , tried the test of the thing where they zap the nerves with electric and I was apparently not a suitable candidate . Last knee surgeon was opposed to me having a knee replacement as I am hypermobile and he reckoned would probably not resolve pain- my knee is usually functionally pretty good - its the pain I struggle with but now it has become weak very suddenly. knee surgeries had TTT, lateral release, fragments removed, torn areas tidied, etc etc.

normally I have been coping ok, providing pace myself knee is usually tolerable but something went very wrong on that fast walk and its significently worse and not improving now so think have shook something loose I should not have.

Other consideration is covid jab- I am 48 and apparently likely to be in line for jab late March /early April. I am reading that steroids can cause issue with jab not working properly if done too close to injection.

sorry for waffling a lot but need to get everything clear in head as to what is best to do
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Re: injections for Grade 3 and 4?

Post by vickster »

You're the same age as me :)

A referral back to orthopaedics would seem sensible.
Could you perhaps see a physio and at least get the knee assessed for any other structural issues, like a ligament or meniscus tear?

Ref Covid jab , yes I'm hoping for April (I think for 40-49s after 15 April is being mentioned), for me that might clash with the scope, so will need to see how that plays out. If it is April, I'll perhaps have to wait for the jab as less urgent!

I think the issue would be more with oral steroids than an injection as that's local not systemic but the medics will have a protocol. I had steroid injections in my ankle in October and the surgeon did say there was a theoretical risk regards Covid but there was zero evidence after many injections done.

Sounds like your issues are more patellofemoral? Perhaps try to seek out a specialist in the patella? Although my kneecap is also worn it doesn't bother me as much, mine is more the outside of knee and leg

I've just started on a low dose of pregabalin to help sleep, just leave me a little fuzzy headed but so did the lack of sleep (and made me grumpy too ;D )!
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: injections for Grade 3 and 4?

Post by Petal »

Thank you. I think its something new as aside from the swelling, the front of knee/shin pain and the subluxating that is kicking off there is something going on behind knee- kind of a painful twanging sensation- no lumps or bumps there but whatever the structure is in the hollow behind knee it is protesting sharply when straighten or turn knee. This is a new thing.

just looked up my telephone consult with GP on their website - I have been allotted one minute for the consult so I best talk quick lol

have decided I am going to ask for referral back to orpho hospital, request stronger pain relief and ask her opinion of whether to pay for a steroid or Cingal injection as its at point now getting up stairs to loo is a painful tricky exercise, likewise sleep. feel better knowing have a plan.
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Re: injections for Grade 3 and 4?

Post by vickster »

Definitely sounds wise to get seen.
There's lots of information in the learning portfolio about arthritis, injections etc. Pain behind knee could be lots of things, bakers cyst, sprained or torn ligament, muscle strain, meniscus tear (very common in the arthritic knee, mine seem to be a shredded mess, ditto my Posterior Collateral Ligament)
Last edited by vickster on Sat Mar 06, 2021 6:59 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
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Re: injections for Grade 3 and 4?

Post by John42 »

Sleeping is a problem with dodgy knees - suggest you sleep with a pillow or cushion between the knees

JohnK/ Manchester UK
Ruptured Patella Tendon January 9 2003
Slipped on black ice.  Manchester UK

Complete Ruptured Tendon
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Re: injections for Grade 3 and 4?

Post by Petal »

cushion- yes that does help.

telephone consult- well that was a waste of time, I have waited a week for this phone consult with a GP. she doesn't know about steroid injections whether would be ok or not, cannot do referrals and couldn't prescribe me stronger pain killers. all she could do was book me in for another 1 minute phone call with a different doctor for one weeks time.

utterly useless!!!! asked me if I had tried ice. said 3 weeks of suddenly a lot worse knee isn't very long. well it feels like a long time when struggling to get up stairs to loo or do housework and not able to walk dog. I think I just need to hope it gets better on its own

I appreciate the practise is really busy with doing vaccinations but really what was the point of the call?
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Re: injections for Grade 3 and 4?

Post by vickster »

That's a shame. Do you have a named GP who knows you and your history?
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: injections for Grade 3 and 4?

Post by Petal »

Thank you Vickster. It is hopefully my own doctor next week so maybe will have a bit more luck- or knee will have settled a bit by then.

Just felt a tad hysterical earlier as was so upset at phone consult- she said oh 3 weeks flare is no time which sent me over the edge a bit. Yesterday I nearly got trapped in the bath !!!

I am at least more composed now, shall rest it up and hope it calms down. From previous experience -and detailed physio in past I know it has got to lose the swelling before it will stop hurting and it won't do that if I keep subluxating because its swollen so if I can't get a steroid to bring it down then will just have to try and not move until it calms.
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Re: injections for Grade 3 and 4?

Post by vickster »

Usual RICE plus an anti inflammatory will hopefully help.
Does it sublux because of the lateral release?

Hopefully you can get in to see your OS fairly soon.

Even privately I'm having to wait for surgery as the hospital is servicing the NHS backlog!
Last edited by vickster on Tue Mar 09, 2021 10:09 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
Petal
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Re: injections for Grade 3 and 4?

Post by Petal »

Its always done it. Didn't hurt when I was younger, improved a lot after TTT surgery but when swollen its all over the place. I think its to do with the hypermobility- other knee does it slightly but thankfully other one its very slight and doesn't hurt, likewise shoulders slide a bit. ankles slide a lot it looks vile- you can see them pop out and in when twist foot which tends to freak people.

wait- yes I am prepared for long wait - I just hope my GP is prepared to add me to the referral list.
at least if get in the queue its progress.
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Re: injections for Grade 3 and 4?

Post by Petal »

still hurting . do you think maybe I've torn/badly stretched a ligament? do they stop hurting eventually? Not had an event as bad as this in years. knee gives me grief if over do it but generally pain reduces after a few days to manageable level.
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Re: injections for Grade 3 and 4?

Post by vickster »

Don't think you'd know without an examination and perhaps a scan?
Normally torn ligaments lead to instability unless you have really good musculature.
I'd be more inclined towards a degenerate meniscus tear given the arthritis in your knee (degenerate menisicus goes hand in hand)..
Can you fully straighten? Or a loose body scraping around in there?

Have you got the appointment booked with your preferred GP to get the referral underway?
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
Petal
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Re: injections for Grade 3 and 4?

Post by Petal »

Thank you. I have a telephone consult with my own GP Monday so hopefully will agree to referral. I am not well muscled as due to normal knee pain don't do as much exercise as I'd prefer to. Its the weakness that thrown me- normally despite subluxations and occassional locking up with catching meniscus it is still pretty functional. this time its weak- major effect to step up on stair with it and cannot do it at all without either stick or hanging off the banister. its like 50% of power has just gone out of leg. and the strength went literally overnight, not gradual but sudden. have full range of motion it just hurts like hell if fully straighten or bend it. I avoid fully bending it anyhow as that makes the meniscus catch and lock.
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