Many orthopedic conditions can be managed without surgery. Modifying your activity to avoid pain, taking over the counter Tylenol or anti-inflammatory medications like Motrin or Aleve, and using ice or heat can be helpful for joint pain. When these DIY techniques are not effective, joint injections are often the next option to manage pain.
Injection Options
Platelet Rich Plasma (PRP)
Platelet rich plasma is an injectable liquid produced from your own blood. The healing properties in the plasma and the platelets are harvested and injected to help your body heal itself.
What is Platelet Rich Plasma? Platelet-Rich Plasma (PRP) is produced from your own blood. Your blood is mainly a liquid called plasma, but also has white cells, red cells, and platelets in it. Platelets are the cells in our body that contain growth factors. These growth factors stimulate the healing process and are very important in the healing of injuries. PRP is plasma with an increased concentration of platelets. To develop a PRP preparation, your blood is drawn. The blood is then placed in a special centrifugation machine. This machine separates the platelets from the rest of the blood. This concentrated form of platelets is called PRP. The PRP preparation is then injected into the injured area. Ultrasound is sometimes used to guide the injection of PRP.
How effective is PRP? The effectiveness of the PRP therapy can vary, and is not guaranteed. PRP therapy is most effective in the treatment of chronic tendon injuries such as tennis elbow. It can be performed in any muscle, tendon, joint, or ligament. There are many research studies currently being conducted on the benefits of PRP therapy. At this time, how effective PRP will be in treating your condition is not known. For this reason, most insurance will not pay for this treatment.
What is the cost of PRP? Currently, at SSM Orthopedics, the cost of a single injection is $510. The cost of two injection sites is $765. This is subject to change, please ask about current pricing when you schedule your appointment.
What are the risks of PRP injection? Your doctor has determined that PRP is a reasonable option for your problem and may be beneficial. The risks associated with this procedure are minimal. The main risk is local infection and pain at the site of the injection. There is no risk for transmitted blood infections as your own blood is used. It is normal to have mild increased soreness or pain at the injection site. The risk of infection, tissue damage, or nerve injuries is similar to cortisone injection. This is a minimally invasive procedure that can be done in the clinic, and you will go home the same day. Your response to PRP injection for your problem is not guaranteed, and it is possible you will not be satisfied or completely satisfied with your results.
How do I prepare for my PRP injection? Prior to the procedure, you should stop all aspirin, anti-inflammatory medications (NSAIDs such as ibuprofen/Motrin and naproxen/Aleve) for 7 days prior to your scheduled PRP therapy. You should also stop prescription anti-platelet medications (such as Plavix, Effient, Brilinta, Pletal) for 7 days before the procedure but only after approval from your cardiologist. All of these medications work by blocking the action of some growth factors in platelets and may make the injection less effective.
What can I expect during my appointment for PRP? You will check in for your appointment. Payment is due at the time of the appointment. Please note that most insurance plans do not cover PRP injections. Nursing staff will draw your blood. The blood will be centrifuged to obtain the PRP. This will take 5-10 minutes. Under sterile technique, the PRP will be injected into the affected area. Your doctor may inject some numbing medication first. Ultrasound may be used to localize the area of injury.
What should I do after the procedure? After the procedure, you may ice the area for 20 minutes every 2-3 hours as needed for pain and swelling. Elevate the area to reduce swelling and soreness. You should limit activity for 1-2 days after the procedure, and then can gradually resume activities. Avoid taking anti-inflammatory medication for 2 weeks after the injection. Because the effectiveness of PRP relies on your own body’s ability to heal, patients typically notice improvement starting in 4-6 weeks and up to 3-6 months.
How should I manage discomfort after my PRP injection? If you are painful after the procedure, we recommend ice and Tylenol. Rarely, some patients can experience a “flare” reaction and have more intense pain for the first few days. This is an inflammatory response, and this temporary increase in pain usually doesn’t last. Please call if you have severe pain, swelling, warmth, redness, or drainage after the procedure.
My injection was in the foot or ankle. Can I walk on it? If your injection was placed in the foot or ankle, you may be fitted with a boot immobilizer. You may be advised to avoid putting weight on the leg for 2 or 3 days. Occasionally, your doctor may prescribe crutches and a few weeks of not weight bearing, depending on the site that was injected. If you are given a boot, you should wear it for 2-3 weeks after the injection. Depending on where your injection was placed and whether your doctor recommends crutches, you may need someone to drive you home after the procedure.
Cortisone Injections
Cortisone is a powerful anti-inflammatory medication, and these injections can be very helpful for relieving pain and decreasing inflammation in orthopedic conditions.
What does a cortisone injection do? Cortisone injections relieve pain and inflammation. Cortisone injections cannot heal damaged tissue or cure arthritis, but can be very helpful in improving symptoms for people with inflamed joints or tendons.
What can I expect during a cortisone injection? Cortisone injections do not typically require pre-authorization. If you and Dr. Burns decide that cortisone injection might be helpful for your orthopedic problem, she will clean and prep the area, use numbing medication, and place the cortisone in the affected area.
Do cortisone injections hurt? Most patients do not say the injection is very painful. Dr. Burns routinely uses numbing medication in her injections, which helps to reduce the pain. She also uses ethyl chloride, a “freezing spray” to numb the area before injecting it.
Viscosupplementation
In a viscosupplementation injection, a gel-like fluid called hyaluronic acid is injected into the knee joint.
What is viscosupplementation? A gel-like fluid called hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads.
How many injections will I receive? Depending on the product used, you will receive one to five shots over several weeks. Dr. Burns typically uses products that require up to 3 injections. Typically, the product selected is dependent on insurance coverage.
What are the different brands of viscosupplementation? Dr. Burns often uses Orthovisc, which requires 3 injections given over 3 weeks. She uses Durolane, which is a single injection. She also uses Synvisc, which requires 3 injections given over 3 weeks, or SynviscOne, which is one injection.
What can I expect BEFORE my injection? You should understand that many insurance companies require pre-certification. Many patients will require a visit to evaluate their knee pain, document the amount of arthritis, and request the appropriate medication.
What can I expect the day of my injection? Dr. Burns will make sure all your questions are answered. Rarely, fluid is drained from the knee before the first injection. The area is prepped and the medication is placed inside the knee joint. If you are receiving a series of injections, Dr. Burns will ask to make sure you have not had any significant reactions to the previous injection before proceeding.
What should I do AFTER my injection? Dr. Burns recommends avoiding exercise or heavy activity for the first 24 hours after the injection. After that, you may resume and increase your activities within the level of your comfort.
When will I notice pain relief? Most patients will notice pain relief 1-2 weeks after the last injection. Some patients will notice improvement right away, but do not be concerned if you don’t notice significant relief after the first or second injection (if you are receiving a 3 injection series).
Can these injections be repeated? Yes, the injections can be safely repeated every 6 months for patients who experience relief of their pain with injections.
Can viscosupplementation be used for any joint? Viscosupplementation is only approved for use in the knee. Using these types of injections in any other joint is not covered by insurance.
What are the side effects of viscosupplementation injection? The side effects sometimes seen after viscosupplementation include: pain, swelling, heat, redness, and/or fluid build-up in or around the knee. Tell Dr. Burns if you experience any side effects after treatment.
Zilretta
ZILRETTA® (triamcinolone acetonide extended-release injectable suspension) is an extended-release corticosteroid approved to manage osteoarthritis knee pain.
What is ZILRETTA®? ZILRETTA® (triamcinolone acetonide extended-release injectable suspension) is an extended-release corticosteroid approved to manage osteoarthritis knee pain. The benefits and risks of repeat injections have not been demonstrated.
Who should not receive ZILRETTA? You should not receive a ZILRETTA injection if you are allergic to corticosteroids, triamcinolone acetonide, or any other component of the product.
What are the most common side effects of receiving a ZILRETTA® injection? In multiple clinical trials, the most common side effects seen in people taking ZILRETTA® were joint pain, headache, joint swelling, back pain, sore throat and runny nose, upper respiratory tract infection, and bruis