Knee Joint Injection

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Knee Joint Injection
Indication

Contraindications

Infection, uncontrolled coagulopathy, joint prosthesis, poor response to previous injections. Allergy to eggs or feathers is a relative contraindication to hyaluronic acid.

Injectate

A variety of options exist for injectates - steroid, visco-supplementation, platelet rich plasma, stem cells, and dextrose prolotherapy.

Technique

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.

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.

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