Injection therapies for
Osteoarthritis in the knee

Knee joint arthritis can have a tremendously negative effect on quality of life, due to pain and loss of activity. This can greatly affect general health.

Non-surgical arthritis treatment comprises weight management, exercises to strengthen muscles and regain joint movement, cross training, medication and sometimes splinting.

For the patient with knee pain who is not responding to other therapies, an injection therapy may be clinically useful.

Knee injections are generally considered safe and reliable. Depending on your condition there are four different therapies which we offer.

Corticosteroid injection

Corticosteroids are part of the group of anti-inflammatory medications. They are used when there is an inflammatory component to joint disease or when there is excessive scar tissue formation.

When administered appropriately they are safe and effective for a few weeks.

The main indication would be to settle joint swelling, to allow rehabilitation to commence. An inflammatory joint disease like gout and rheumatoid arthritis also respond rapidly to corticosteroids.

Occasionally there are mild side effects following single dose use. The commonest is a flare of pain for a day, which will usually respond to paracetamol and application of ice to the knee. Some may experience facial flushing or red cheeks for a day but this passes. Infection is fortunately very rare and is heralded by increasing pain, redness and swelling of the knee. If you get these symptoms you should seek medical opinion the same day.

Visco supplementation

This is a group of injectable medications which mimic healthy joint fluid which is thick (viscous). Joint fluid transports an array of chemicals to the cartilage and synovial cells which line the joint cavity.

It is sold as “Durolane”, “Synvisc” and “Osteoartz” in New Zealand. It can provide short-term (4-12 week) relief from painful knee symptoms. As such it may be used for short-term relief such as prior to an active holiday in a patient with mild knee osteoarthritis.

The cost is borne by the patient as it is generally not covered by ACC or Health Insurance.

Platelet Rich Plasma (PRP)

Our blood consists of red and white blood cells, platelets and serum. Serum contains a multitude of different biologically active chemicals (cytokines). These can be both anti-inflammatory and pro-inflammatory.

PRP is obtained by centrifuging about 10mL whole blood and using the cell-free component as a joint injection. This concentrates the cytokines and has the effect of reducing pain and inflammation in affected joints. There can be a short-lived flare of pain over 2-5 days which can be managed with paracetamol and ice and activity reduction.

We ask patients to avoid anti-inflammatory (e.g. Voltaren, ibuprofen) for a week prior to this injection.

The pain reducing effects are variable but usually last 3-5 months.

Orthokine/Autologous Conditioned Serum

Orthokine has been shown to be superior to placebo and hyaluronic acid injections, and to have a longer effect on reducing pain and increasing activity (1-2 years) when compared with PRP (see paper attached showing comparisons in effect and how long effects last).

Interleukin-1(IL-1) is a joint cytokine which speeds up joint damage when triggered. Fortunately, there is a blocking chemical, Interleukin 1 receptor antagonist (IL-1Ra), which can block this effect in a damaged and inflamed joint.

This IL-1Ra can be increased in our own blood by a special technique and then injected into the affected joint. This method was developed about 20 years ago in Germany. The proprietary method is called “Orthokine”. Dr Tony Page first started using this method on patients in Melbourne in 2010 with good results.  Dr Page is able to offer this therapy at ForteSports as a series of injections over 4 weeks.

We take four 10mL tubes of blood in the morning and process your blood on site through the day. You then return on the same day to have the first of four joint injections.

Relative rest is recommended for about 5 days, but cycling, swimming and walking are fine for this period. The patient then follows a strengthening programme with their physiotherapist (see paper attached of a group of patients awaiting joint replacement therapy).