Knee Arthritis Injections vs Surgery

What are the injectable options for knee arthritis?

Intra-articular injections into the knee joint also have a useful role in treating knee arthritis. The first type of injection is a steroid injection which helps to calm down the inflammation in the joint. Steroids have the longest track record of all injection types and are the most frequently utilized type of injection. As a word of caution, there may be some concern about the potential catabolic cartilage breakdown effects of steroid injections. Also, whenever a patient is considering these injections, we want to make sure that a patient’s blood sugar is well controlled as these can spike blood sugar especially in our diabetic patients. Overall though, steroid injections are very well tolerated in the office and when used for arthritis flare-ups or in end-stage bone-on-bone arthritis, patients often do reasonably well with these.

A second type of injection is called Viscosupplementation or gel type injections. These contain hyaluronic acid and are most commonly used in our younger patients dealing with early knee arthritis or the more elderly patients greater than 80 years old as both groups do very well with this. However, patients with severe bone-on-bone arthritis tend to not have an ideal response to these gel type injections. There are different formulations and series of gel type injections where some formulations are one injection only and some require a series of three injections spaced out over three weeks. In some cases, a steroid injection may not work in a patient but visco-supplementation might work much better. Thus, we can determine this on a patient-by-patient basis.

Another type of injection that’s receiving more attention in the orthopedic community is something called Platelet-Rich Plasma (PRP) injections. There are some higher quality evidence papers in the literature showing that PRP can be helpful in slowing down the progression of arthritis especially in mild to moderate arthritic cases. Briefly discussing the PRP technique, we would take a small amount of a patient’s own blood, spin it down with a centrifuge, concentrate it to a layer of growth factors and platelets, and utilize ultrasound to precisely inject the PRP into the knee joint which helps recruit healing properties and induce good inflammation to help reset the environment of the knee.

Currently, PRP for knee arthritis is not routinely covered by insurance and so there is an out-of-pocket cost that we would discuss with patients to see if it would be in line with their priorities. While PRP may not be right for all patients, it is something we discuss as a possible alternative to steroid injections or viscosupplementation as some studies may indicate that the best combination of injections for the knee to reduce inflammation may be a combination of viscosupplementation and PRP injections.

What are the surgical options for knee arthritis?

One surgical option we can consider is knee arthroscopy with small incisions to try and buff up any irregular cartilage (chondroplasty) and clean torn up and irritated meniscus. However in the current age, arthroscopy in the setting of known knee arthritis does NOT substantially alter the natural history of their disease unless if there’s a displaced mechanical flap of cartilage or meniscus that is focally irritating the knee that would have benefit in being removed. Thus, for most patients, I do not believe that arthroscopy provides significant benefit when compared to the risks of potentially accelerating arthritis and do not routinely recommend this.

If patients have truly exhausted extended non-operative treatment and their pain and function are compromised to a point of substantial detriment to daily quality of life, then undergoing knee replacement (arthroplasty) is a reliable and proven option to eliminate pain and get back to a high level of function. Arthroplasty can be in the form of a Unicompartmental Knee Arthroplasty (UKA if only one compartment is predominantly affected and the other two compartments are relatively unaffected. If arthritic disease is more extensive in multiple compartments, then we would instead recommend a Total Knee Arthroplasty (TKA). While most patients do very well with undergoing arthroplasty, there is no such thing as a “minor” or “easy” surgery. We take every surgery seriously because we want to provide the optimal outcome for our patients. Briefly, a knee replacement basically entails a patient going under anesthesia, an incision is made on the front of the knee, and then precise saw cuts are made to remove the worn down cartilage portions of the knee including from the kneecap. The minimally removed bone is then replaced with metal and plastic to help reconstruct the knee. Following this, patient’s would undergo a structured course of rehabilitation under the direction of a physical therapist to make sure they are recovering well.

If you have symptoms consistent with knee arthritis, you are always welcome to call our office or book an appointment with knee surgeon Dr. Charls. Dr. Charls takes great care in diagnosing and treating knee arthritis on an individualized, patient specific basis. Dr. Charls sees patients at his Paris office at Paris Orthopedics and Sports Medicine and operates at both Paris Surgery Center and Paris Regional Health.