An intra-articular knee injection is a procedure where an anti-inflammatory or joint replacement fluid (visco-supplementation) medication is placed directly into the knee joint.
What conditions are treated with intra-articular knee joint injections?
Acute and chronic knee pain can be treated with a knee injection. Commonly treated conditions include osteoarthritis, rheumatoid arthritis, and cartilage or meniscus tears.
Osteoarthritis is a common form of arthritis that often affects the knees. It develops when the cartilage breaks down. Common symptoms include causing pain, swelling, stiffness, and disability.
Rheumatoid arthritis is an autoimmune condition in which the body’s protective mechanisms attack the joints of the body. Common symptoms include swelling, redness, stiffness, and joint warmth.
Cartilage or meniscus tears are a common injury of the knee. The meniscus is a crescent shaped cartilage structure that provides a cushion to your knee. Tears in this cartilage can occur often during sports or other physical activity. Symptoms are typically pain, swelling, and joint catching or popping.
How is the procedure performed?
Our team will help position you to make sure the procedure can be completed with the least amount of discomfort for you. The skin is cleansed with a sterilizing solution (chlorhexidine) and a sterile drape is placed. A local anesthetic medication typically (Lidocaine) is given to numb the skin. Sometimes fluoroscopy (x-ray) or ultrasound is used to find the target. A thin needle is directed to the desired location. A local anesthetic and/or steroids are then injected. During the entire procedure you will be constantly monitored by our team. After the injection a small bandage is placed on your skin. You will be given time after the procedure to make sure you feel good and are not having side-effects before leaving the clinic.
What medication is injected?
A steroid injection is a combination of anesthetic (lidocaine or bupivacaine) and steroid (cortisone, Kenalog or dexamethasone). The local anesthetic will be responsible for the immediate relief and the steroid is used to provide more long-term relief.
Visco-supplementation (Synvisc or Hyaglan) injection is a gel-like fluid called hyaluronic acid. Hyaluronic acid is a substance found in the synovial fluid surrounding the knee joints. It acts as a lubricant and as a shock absorber.
Does the procedure hurt?
The procedure is typically well tolerated. A localized burning sensation from the anesthetic is commonly felt and is usually the most uncomfortable part of the process. During the procedure a pressure sensation is often experienced this typically resolves within a few minutes. Minor soreness for a week after the procedure is normal.
How long does the procedure take?
The procedure typically takes about 15 minutes to perform. Please plan on being at the clinic for about 1 hour to allow for pre and post-procedural safety protocols.
How quickly will I get relief?
It can take up to a week for the steroid medicine to reduce pain and inflammation. Our team will follow-up with you and determine the need for any future injections.
How long can I expect the relief to last?
Every patient is different. Most patients get reduced pain lasting 2-4 months. Some patients can get relief lasting greater than a year.
How often can the procedure be repeated?
Depending on results and providers discretion the injections may be repeated up to 3-4 times per year for sustained pain relief.
Will the steroid injection result in more health problems long term?
There is minimal absorption from steroid injections to other areas of the body. For this reason, many of the side effects that occur with systemic steroid usage do not occur with local steroid injections. The systemic side effects of weight gain, osteoporosis (thin bones), and increased blood pressure typically do not occur with steroid injections.
Can I have the injection if I have diabetes?
Yes. It is important to control your blood sugar before and after the injection. Diabetic patients may experience a temporary increase in blood sugar which should resolve in a few days after the procedure.
What are the risks and side effects?
Risks and side effects are minimal and serious complications are rare. We take every precaution to ensure safety. Potential risks may include but are not limited to: vasovagal response (passing out), new or increased pain, infection, bleeding, permanent skin changes, allergic or unexpected drug reaction with minor or major consequences, and unintended nerve injury.
Please let us know if you have an active infection, are using antibiotics, or are using blood thinners.
Should I take my normal medications as scheduled?
Yes. Continue taking your prescribed medications prior to procedure.
What If I am on a blood thinner or Aspirin?
Anticoagulation is typically continued before the injection.
Do I need a driver?
Yes. For your safety we require a driver to ensure safe return home.
Can I eat the day of the procedure?
It depends on the location. We recommend eating a light meal if the injection is done in our clinic. If the procedure is done at the surgery center then you must fast for at least 8 hours prior to the procedure.
Can I get sedation or anesthesia?
Most patients do well without sedation. Light sedation with oral medications is sometimes provided at the provider’s discretion.
What if I am pregnant?
There are serious potential risks to an unborn fetus when exposed to imaging studies, including x-ray and fluoroscopy. If there is any chance you may be pregnant, please postpone this procedure until it can be confirmed that you are not pregnant as it is not safe to do during pregnancy.
What should I wear?
We recommend light loose-fitting clothes. Sometimes we will ask you to change into a gown.
When can I drive after the procedure?
We recommend resuming driving the next day.
What can I do if I am sore or have pain after the procedure?
Ice packs can be applied to the area for 20 minutes per hour. Over the counter Tylenol and Motrin can be used to aid with any discomfort.
What are my restrictions after the procedure?
Typically, you may resume light activities on the same day following your procedure. Physical therapy can be re-started within 24 hours. We recommend returning to work the day after the procedure.
When can I shower?
Showering the day of the procedure is allowed. For 24 hours you are asked to refrain from submerging or swimming in water. Keep the bandage on for one day.
When do I come back for a follow-up visit?
We follow-up with all of our patients after their procedures. We typically see patients back in 2-4 weeks.