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Knee Joint Injection: Difference between revisions
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{{procedure | {{procedure | ||
|indication= | |indication= | ||
|syringe= | |syringe=10mL | ||
|needle= | |needle=20-27g | ||
| | |injectate=Steroid, hyaluronic acid, PRP, dextrose | ||
| | |steroid=0.5-2mL of steroid (e.g. 20-40mg triamcinolone) | ||
|local= | |local=5-10mL of 1% lidocaine or 0.25% to 0.5% bupivacaine | ||
|volume= | |volume=5-10mL | ||
}} | }} | ||
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*Clean the skin | *Clean the skin | ||
*Draw up the injectate mixture. | *Draw up the injectate mixture. | ||
* | *Optional infiltration of skin with 3-5mL local anaesthetic with 27-30g needle. | ||
Use a | *Use a 20-27 gauge 1 inch needle on a 10 ml syringe to enter the joint. | ||
*Approach | |||
**Lateral: Enter the skin 1 cm superior and 1 cm lateral to the superior lateral aspect of the patella; direct the needle at a 45° angle, tilting below the patella, and aim toward the middle of the medial side of the joint | |||
**Medial: Enter the medial aspect of the knee at the middle of the patella, aiming toward the lateral midpole. | |||
**Anterior: The patient's knee should be flexed 90°; keeping the needle parallel to the tibial plateau, enter just medial or lateral to the patellar tendon | |||
*May feel a "pop" when penetrating the joint capsule. Flow of the injection should not meet resistance. | |||
*Change the path of the needle slightly if injecting the medication is difficult; the needle may be within a fat pad or thick synovium. | |||
*Redirect or withdraw the needle if severe pain occurs; the needle may be hitting the cartilaginous surface. | |||
*Apply a bandage after withdrawing the needle. | |||
==Complications== | ==Complications== | ||
Repetitive intra-articular corticosteroid injections may cause accelerated cartilage loss. McAlindon evaluated triamcinolone vs saline repeated every 12 weeks for 2 years in 141 patients with knee osteoarthritis. The steroid group had greater cartilage loss (-0.21 mm vs -0.10mm), and no significant difference in pain. There was a small increase in HbA1c levels in the steroid group. The steroid group had 5 complications, and the saline group had 3.<ref>{{#pmid:28510679}}</ref> | Repetitive intra-articular corticosteroid injections may cause accelerated cartilage loss. McAlindon evaluated triamcinolone vs saline repeated every 12 weeks for 2 years in 141 patients with knee osteoarthritis. The steroid group had greater cartilage loss (-0.21 mm vs -0.10mm), and no significant difference in pain. There was a small increase in HbA1c levels in the steroid group. The steroid group had 5 complications, and the saline group had 3.<ref>{{#pmid:28510679}}</ref> | ||
Other complications include bleeding, infection (1:10,000), postinjection flare (1%-2%), no response, non-sustained response, temporary glucose elevated. Allergic reactions are rare. | |||
Specific to hyaluronic acid is that it can more frequently cause pain and can cause a large joint effusion, rash, and itching. | |||
==Aftercare== | ==Aftercare== | ||
Rest the knee, avoid strenuous activity for 48 hours, shower/bathe as normal. Post-injection flares can be treated with ice and NSAIDs. Safety netting for injection. | |||
==Videos== | ==Videos== | ||
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{{Reliable sources|synonym1=""|synonym2=""|synonym3=""}} | {{Reliable sources|synonym1=""|synonym2=""|synonym3=""}} | ||
[[Category:Infobox Templates]] | |||
[[Category:Infoboxes]] | [[Category:Infoboxes]] | ||
[[Category:Knee & Leg Procedures]] | [[Category:Knee & Leg Procedures]] | ||
[[Category:Stubs]] | |||
Revision as of 14:26, 2 April 2021
This article is a stub.
| Knee Joint Injection | |
|---|---|
| Indication | |
| Syringe | 10mL |
| Needle | 20-27g |
| Injectate | Steroid, hyaluronic acid, PRP, dextrose |
| Steroid | 0.5-2mL of steroid (e.g. 20-40mg triamcinolone) |
| Local | 5-10mL of 1% lidocaine or 0.25% to 0.5% bupivacaine |
| Volume | 5-10mL |
Anatomy
Indications
Contraindications
Infection, uncontrolled coagulopathy, joint prosthesis, poor response to previous injections. Allergy to eggs or feathers is a relative contraindication to hyaluronic acid.
Pre-procedural Evaluation
Injectate
A variety of options exist for injectates - steroid, visco-supplementation, platelet rich plasma, stem cells, and dextrose prolotherapy.
Equipment
Technique
Ultrasound Guided
Fluoroscopy Guided
Landmark Guided
- Protective gloves and use sterile technique.
- Position: Lie supine with the knee slightly flexed, supported underneath with a rolled towel or cushion.
- Palpate and identify the borders of the patella and mark the entry site
- Clean the skin
- Draw up the injectate mixture.
- Optional infiltration of skin with 3-5mL local anaesthetic with 27-30g needle.
- Use a 20-27 gauge 1 inch needle on a 10 ml syringe to enter the joint.
- Approach
- Lateral: Enter the skin 1 cm superior and 1 cm lateral to the superior lateral aspect of the patella; direct the needle at a 45° angle, tilting below the patella, and aim toward the middle of the medial side of the joint
- Medial: Enter the medial aspect of the knee at the middle of the patella, aiming toward the lateral midpole.
- Anterior: The patient's knee should be flexed 90°; keeping the needle parallel to the tibial plateau, enter just medial or lateral to the patellar tendon
- May feel a "pop" when penetrating the joint capsule. Flow of the injection should not meet resistance.
- Change the path of the needle slightly if injecting the medication is difficult; the needle may be within a fat pad or thick synovium.
- Redirect or withdraw the needle if severe pain occurs; the needle may be hitting the cartilaginous surface.
- Apply a bandage after withdrawing the needle.
Complications
Repetitive intra-articular corticosteroid injections may cause accelerated cartilage loss. McAlindon evaluated triamcinolone vs saline repeated every 12 weeks for 2 years in 141 patients with knee osteoarthritis. The steroid group had greater cartilage loss (-0.21 mm vs -0.10mm), and no significant difference in pain. There was a small increase in HbA1c levels in the steroid group. The steroid group had 5 complications, and the saline group had 3.[1]
Other complications include bleeding, infection (1:10,000), postinjection flare (1%-2%), no response, non-sustained response, temporary glucose elevated. Allergic reactions are rare.
Specific to hyaluronic acid is that it can more frequently cause pain and can cause a large joint effusion, rash, and itching.
Aftercare
Rest the knee, avoid strenuous activity for 48 hours, shower/bathe as normal. Post-injection flares can be treated with ice and NSAIDs. Safety netting for injection.
Videos
See Also
External Links
References
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
