The knee can be affected by a variety of different conditions ranging from traumatic injuries to gout, rheumatism and arthritis. Unknown to most, many of these conditions are likely to benefit from conservative management. Injections into the knee joint cavity have proven to be particular popular with patients as they a relatively painless, easy to administer and often provide almost instantaneous pain relief. 

 

Sometimes removing fluid from a joint may provide vital clues to the clinician as to what may be the reason for the patients complaint, as different types of joint fluid may help in diagnosing and treating various knee conditions. Infections and gout are two classic examples which can easily be diagnosed by aspirating the joint. Cartilage debris is commonly present in joints affected by arthritis and degenerative joint disease. Removing it will not only reduce inflammation and pain, but also assist joint movement. An array of different injectable substances are at the perusal of the clinician these days, allowing to customise treatment to the patient and the specific condition. Injecting anaesthetic into various aspects around the joint may also help the clinician to distinguish between different pains and define the origin of a particular problem. Steroids have served as anti-inflammatories since the beginning of the last century and in more sophisticated form still available today. They are particularly helpful in settling acutely inflammed and swollen joints, but care must be taken not to inject overzealously. Your clinician would be able to advise you on this and safeguard that the amount of steroids administered are tailored to your needs. 

 

The introduction of ‘Hyaluronate Injections’ in the treatment of degenerative joint disease has been one the most significant development in recent years. It has improved the life quality of numerous arthritis sufferers across the globe by delaying the need for joint replacement surgery for many years. Due to the lack of hyaluronate, joint fluid in arthritic joints is less viscous and hence less well equipped to withstand the stresses and strains a knee joint is exposed to even during normal activities. Subsequently even simple tasks may become painful and stiffness occurs when trying to move after prolonged periods of rest. Injecting Hyaluronate increases the joint fluid viscosity and stimulates its endogenous production within the joint. Although the the exact mechanism of action is not fully understood, researchers suggest that Hyaluronate exerts anti-inflammatory, analgesic, and chondroprotective effects on the joint and articular cartilage. If successful the joint will then start to produce the improved fluid for many months allowing the joint to function more normally and, above all, causing significantly less pain. To achive the effect three to five injection may be necessary, which are administered in weekly intervals. The patient can anticipate the effect to continue for up to 18 months.  

 

 

 

What is Hyaluronic acid? Hyaluronic acid, also known as Hyaluronate, is a substance which occurs naturally inhealthy joint fluid. It is made out of long chain sugar components, so called polysaccharides and due to its viscoelastic properties serves the joint both as a lubricant and shock absorber. If a joint is affected by wear and tear (degenerative changes)  or osteoarthritis the normal concentration and molecular weight of hyaluronate in the joint fluid decreses by up to 50%. This has wide ranging consequences for the normal functioning of the joint as the mechanical properties of the fluid are impaired. Due to the lack of hyaluronate, joint fluid in arthritic joints is less viscous and is hence less well equipped to withstand the stresses and strains a knee joint is exposed to even during normal activities.    

 

How does hyaluronate work? Intra-articular Hyaluronate injections are gaining in popularity as part of the non-operative management of patients with osteoarthritis or other joint problems. The injections are designed to introduce a highly viscous fluid into the knee cavity which not only improve joint lubrication but triggers a memory within the cells responsible for fluid production (synoviocytes). The purpose of viscosupplementation is hence not only to replace the lost amount of Hyaluronate but to stimulate its endogenous production within the joint. Although the the exact mechanism of action is not fully understood, researchers suggest that Hyaluronate exerts anti-inflammatory, analgesic, and chondroprotective effects on the joint and articular cartilage.