What are hyaluronic acid injections?
Hyaluronic acid (HA) is a naturally occurring substance in our bodies. It makes up parts of our skin, eyes, intervertebral discs and joints. HA is very hydrophilic, attracting water and one of the main functions of HA in our joint is to act as a joint lubricant helping to nourish the joint cartilage and to act as a shock absorber.
What types of hyaluronic acid injections are there?
There are many different products on the market such as Ostenil, Durolane, Synvisc or Cingal. Depending on which product is used you require between one and three injections into the effected joint over the course of a few weeks. The hyaluronic acid injections we use at Wandsworth Physiotherapy are either Durolane or Ostenil Plus.
Durolane is a non animal source, high molecular weight hyaluronic acid. It has greater cross-linking between the molecules, which helps to increase the half life of the product (how much time the product stays in the joint). Durolane has been shown to reduce pain and stiffness in mild to moderate hip and knee arthritis and can last 6-12 months. Durolane comes in two sizes – a 3ml pre-filled syringe containing 60mg for larger joints and a 1 ml pre-filled syringe containing 20mg of HA for smaller joints such as elbow wrist, fingers and toes.
We also use Ostenil Plus, plus which is a another highly purified sodium hyaluronate (hyaluronic acid). Ostenil Plus comes with the addition of mannitol, a free radical scavenger, which helps to stabilise the hyaluronic acid chains. Ostenil Plus comes in a pre-field 2 ml syringe containing 40 mg of hyaluronic acid. Ostenil Plus also produce a smaller product for smaller joints as well as Ostenil Tendon which can be used to inject into tendon sheaths and bursa.
Why would you have a hyaluronic acid injection?
One of the signs of arthritis in our joints is that we start to have less synovial fluid within the joint making the joint stiff and achy. HA can be injected into the joint to help to replace this joint fluid and help to preserve joint cartilage. Injecting HA into arthritic knee joints has been shown to improve function and reduce pain for up to 6 to 12 months.
Numerous clinical trials have shown that HA is both effective and safe for intra-articular injections, such the knee joint, the shoulder, or the hip joint. It is believed that HA has a multitude of affects when it has been injected into a painful joint. This includes having an anti-inflammatory effect by inhibiting immune cells which break down cartilage and reducing inflammatory mediators within the joint. HA helps to restore joint homoeostasis by stimulating the joint to produce more of the body’s own HA. It has a painkilling affect by modulating and inhibiting pain receptors within the joint. It also has a protective effect on the cartilage itself forming a mesh light network over the joint surface and it has also been shown to delay a breakdown of cartilage within the joint that happens with osteoarthritis.
HA can also be injected into tendon sheaths and around painful tendons, as well as injected into a painful bursa such as the subacromial bursa in the shoulder. HA has an anti-inflammatory effect within these tissues helping to calm down pain and inflammation and restore function.
Ultrasound guided hyaluronic acid injections
At Wandsworth physiotherapy and Osteopathy we can perform ultrasound guided intra articular hyaluronic acid injections into knee, shoulder, and hip joint using ultrasound guidance. We can also use a product called Cingal, which is a combination of 88mg of HA combined with triamcinolone, a corticosteroid. This can be injected into the knee joint to calm the pain of knee joint arthritis. We can inject hyaluronic acid into the shoulder bursa as an alternative to corticosteroid injections as the HA has a powerful anti-inflammatory effect, without the side effects of tendon damage that accompanies steroid injections.
Are there other injections for hip and knee arthritis?
Other ultrasound guided injections that are useful for hip and knee arthritis as well as arthritis in other joints include steroid injections and platelet rich plasma injections. Steroid injections are useful if you have mild to moderate arthritis that is not being managed with over the counter paracetamol and / or ibuprofen as well as non-pharmaceutical interventions such as weight loss and exercise, especially if you arthritis joint is swollen. The steroid will help to bring swelling down and settle pain. Interestingly we can combine steroid with Durolane or Ostenil Plus for longer lasting results.
There is evidence that repeated steroid injections in to the same joint may cause longer term harm, so we start to think about managing ongoing pain and discomfort from arthritis with hyaluronic acid and PRP. PRP injections are also very useful either alone or in combination with hyaluronic acid. In fact a combined PRP / HA injection has been shown to be more effective in managing the pain and stiffness from arthritic joints that either injection on it’s own. We can combine a PRP injection with either Durolane or Ostenil Plus.
If you’re suffering and need an ultrasound guided steroid, PRP or hyaluronic acid injection contact us today.
