Hyaluronic acid

Hyaluronic acid (HA) is a natural compound found in our joints; it plays a crucial role in lubrication and shock-absorption of a joint. HA injections are designed to help lubricate joints and restore normal homeostasis (maintenance) of the joint, which reduces inflammation, pain and stiffness to improve symptoms and allow the patient to engage in rehab exercises and strengthen the muscles surrounding the effected joint.

This treatment is considered for conditions that effect the production of HA, such asosteoarthritis.

The sodium hyaluronate in all versions of OSTENIL® injections is very pure and is manufactured using a process called fermentation. It contains no animal proteins, which means that it is very unlikely to cause an allergic reaction. OSTENIL® has been given to thousands of patients and has not been found to cause any serious side effects. The exact make-up of the sodium hyaluronate in OSTENIL® has been carefully chosen so that it is as effective as possible in treating osteoarthritis

Corticosteroid (Steroid) injections

Corticosteroid injections have been widely used for pain relief in musculoskeletal (MSK) medicine and rheumatology since the 1940s. They are widely delivered in the NHS for the management of osteoarthritis pain and other MSK conditions- including bursitis, carpal tunnel and certain tendon related conditions. 

The aim of the injections is to help relieve inflammation (swelling) and pain. The injection should reduce pain for up to 6-8 weeks and allow you to slowly return to your normal activities and engage in your rehabilitation programme from your physiotherapist. 

The primary steroid used at The Abbey clinic isDepo-Medrone(methylprednisolone acetate). This is a common potent slow-release steroid that is commonly used in Rheumatology and orthopaedics for a range of musculoskeletal disorders. 

Which injection is right for me?

*Could be considered as a primary intervention alongside conventional therapy.

**Could be considered if pain is the primary issue and conservative therapy hasn’t helped on its own. There may be some caveats to this and will be individual specific.

***Very much further down the treatment option pathway (beyond conservative measurers/rehab, orthotics and a course of shockwave therapy). 

FAQ:

What are the benefits of having an injection?
The injection can help to reduce the irritability and severity of your symptoms to allow continued rehabilitation and conservative treatments.

How fast does the injection work?
You will probably not notice any benefits immediately after the first injection, but you should gradually start to feel less pain and stiffness over the next few weeks. The improvement in your symptoms is likely to persist for several months, depending on the progression of the degenerative change in the joint being treated.

When the effects of your OSTENIL® (hyaluronic acid) injections begin to wear off, you can safely choose to have another injection if your clinician agrees it is appropriate.

Is the injection painful?
You should expect to feel some pain during the procedure. All efforts will be made to minimise discomfort.

Whilst the area that is going to be injected can remain sore for the next 48 hours, it is usually safe to take over the counter pain relief to relieve symptoms. (Subject to your own allergies)

How is the injection done?
A standardised aseptic technique is used. The skin is cleaned with antiseptic, a needle is gently put into the affected area, and the solution is injected through a needle.

What are the possible side-effects of an injection?
They include the following and a more detailed list can be found on the manufacturer’s information: 

• Cosmetic changes including reduced skin pigment and/ or dimpling of the skin at the injection site  
• Flushing of the face for a few hours 
• Bruising at the injection site (more likely if you are on blood thinning medications) 
• A temporary increase in pain (up to 3-5 days) 
• Numbness, tingling or increased pain if a nerve has been touched by the needle 
• Tendon rupture 
• Slight vaginal bleeding 
• Diabetic patients may notice a temporary increase in blood sugar levels and should monitor these after the injection for up to 10 days, seeking medical advice as needed 
• Changes in mood. This is more likely if you or your family have a history of psychosis 
• Increased blood pressure, which is unlikely to be noticeable unless your blood pressure is currently not controlled 
• Post injection joint infection. This is very rare, one person in 10,000 may experience this. If the area that was injected becomes hot, red, swollen and very painful, or if you feel unwell within 24-72 hours after the injection you should seek urgent medical attention 
• Other infections: Avoid close personal contact with unwell individuals following steroid injection. For example, people with Chickenpox, measles, and tuberculosis, especially if you have not had chickenpox or completed routine childhood vaccinations 
• Anaphylaxis, which is a life-threatening allergic reaction. Anaphylaxis is extremely rare in response to injected steroids or local anaesthetic.  

You will be asked to wait for up to 30 minutes after the injection to ensure you do not have any immediate adverse reaction to the injection. 

Who is going to administer the injection?
A specialist physiotherapist, who has undertaken further injection training to assess and administer the injection safely.

• You will be asked to wait for up to 30 minutes after the injection to ensure you do not have any immediate adverse reaction to the injection. 

Are there times when I should not have an injection?
Yes, if you: 

• Have an infection on your skin or anywhere else in your body 
• Are allergic to Lidocaine (local anaesthetic) or steroids 
• Feel unwell 
• Are due to have surgery in the area in the next 6 months  
• Are pregnant or breast-feeding 
• Have a replacement joint at the injection site 
• Are under 18 
• Have poorly controlled diabetes and/or hypertension 
• Do not want the injection 

Your clinician will discuss these factors with you when deciding whether it is safe for you to have the injection. 

How long can the injection last?
One injection of the Hyaluronic acid injection, can reduce pain and improves function in knee OA over 6 months.

The injection should reduce pain for up to 6-8 weeks and allow you to slowly return to your normal activities and engage in your rehabilitation programme from your physiotherapist. 

Will I have to be seen again?
You will have a follow up with your injecting physiotherapist, either face to face or via telephone call.