Knee Joint Injection
Knee Joint Injection | |
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Indication |
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.
Use a combination of 5 to 10 ml of 1% lidocaine or 0.25% to 0.5% bupivacaine mixed with 0.5 to 2 ml of the selected steroid (20-80 mg of methylprednisolone acetate, 20-40 mg of triamcinolone acetate or 6-12 mg of betamethasone acetate/phosphate). Hyaluronic acid injections come in 2 ml prefilled syringes given once per week for 5 weeks for Hyalgan and once per week for 3 weeks for Synvisc.
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]
Aftercare
Videos
See Also
External Links
References
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,