These are the most common type of injections that we do.  The problem with arthritis is usually due to inflammation in the joint which irritates the joint lining which causes increased fluid production which in turn causes joint pain and stiffness.  The steroid that we would inject into the joint will decrease the inflammation which in turn decreases irritation, knee pain, and stiffness.  We combine our steroid with a numbing medicine which helps with immediate pain relief.  These injections typically take one to two days to start working and usually provide relief for three or more months.  You can be repeat injections every three to four months if the pain comes back.  This is a good option for most people.  It works in about 90% of patients.  However, we find the more shots you have the less they tend to work.

A downside to the steroid injection is that it can raise your blood sugar.  The steroid is not as widely absorbed throughout the body when it is injected into the joint so these steroids have less of a chance to affect things like blood sugar or blood pressure.  If you do need insulin for diabetes, we recommend you checking your sugars regularly for at least 2 days after an injection to make sure they stay normal. Another downside to having a steroid injection is that it puts you at risk for infection if you would have a surgery too soon after an injection.  Because the steroid stays in your joint for about 3 months and decreases your immune response, we don’t like to operate until there is less of a chance for infection so our doctors are currently recommending a period of at least three months in between injections and joint replacement.

The other popular injection you may have heard about has several nicknames: gel shots, chicken shots, and rooster shots.  These are names for a type of injection called viscosupplementation which uses a special type of substance called hyaluronic acid.  This is a type of gel which tries to replace the normal joint fluid that you lose when you have arthritis.  An arthritic joint creates joint fluid that is very watery and doesn’t support the bones as well as normal joint fluid which is thick like Jell-O.  Thicker joint fluid provides more cushion between the bones and prevents them from rubbing and grinding as much.

A drawback to these injections is that they only tend to work in about 60% of patients and may not be fully covered by insurance.  These injections also take longer to work and you need to have one shot a week for three weeks.  The injections tend not to be first line because of these reasons, but the are a reasonable alternative to try if you have failed other conservative management like therapy, weight loss, and steroid injections.

If you think you might be a candidate for a knee injection or have more questions about steroid injections or viscosupplementation, make an appointment with one of our joint doctors today.

Julia Grunebach, PA-C