TYPES OF KNEE INJECTION

Knee osteoarthritis is becoming more prevalent in Malaysia as we move towards becoming an ageing society. The ultimate treatment for these patients has always been knee replacement surgery. However, general consensus is that we always delay the surgery as long as possible since the implants used also have its own lifespan. As such, intraarticular knee injection as an option which provides temporary relieve for these patients.

There are many types of knee injections. The choice usually depends on current knee condition, age, affordability and underlying medical problems.

1) Corticosteroid Injection

Patient given triamcinolone injection which last around 3months. It gives immediate relieve especially if combined together with local anaesthetic agent. It is best to be given for patient suffering from acute inflammatory conditions, whereby we can remove the effusion and administer steroid. However, steroid poses risk of having long term side effect such damages in supporting soft tissue and bone necrosis. This will effect the outcome of surgery if patient had to go for knee replacement later.

2) Viscosupplement Injection ( HA)

Viscosupplement injections are basically injecting synthetic lubricant material into the joint capsule. It is suitable for early stage of osteoarthritis. It is generally safe and can be given repeatedly. The effects lasts around 6months to 1 year, depending on the quality of the HA and the staging of the disease. It does not reverse the progression of the disease.

3) Platelet Rich Plasma (PRP)

Platelet are blood components which is activated during injury. It primarily releases blood coagulation material. However it also produces multiple types of growth factors and exosomes which helps in healing. PRP preparation procedure, done correctly, will increase the concentration multiple fold. PRP takes around 1 month to show the effect and PRP will continue to repair the damaged the knee surface for up to 3 months. It has almost no side- effect but the result varies according to the patient and the person who prepares it. PRP has shown to be able to reverse the degeneration of the joint surface.

4) Prolotherapy

Using almost similar concept as PRP, prolotherapy is a treatment for arthritis by inducing inflammation. However, the success rate usually lesser compared to PRP and the studies behind this treatment is not as convincing as well. This is partially because there are no multiplication effect for prolotherapy.

5) Stem cell/ exosome

Mesenchymal stem cell are usually harvested from umbilical cord and proliferated in lab before injected into the joint. Exosome are stem cell by product which also helps regeneration of the tissues. Among the major issues in stem cell treatment is the quality of the stem cell itself. Stem cell are very sensitive to temperature and has very short lifespan. Hence the cost to administer high quality stem cell can be quite high.