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    Osteoarthritis: What Should You Do?

    Osteoarthritis (OA), the most common joint disorder in the United States, impacts an average of 25 million people in this country. However, treatment options abound. At University Orthopaedic Associates (UOA) we understand the challenges of osteoarthritis. Read below for helpful advice on treatments for this condition.

    What is Osteoarthritis (OA)?

    Osteoarthritis (OA) is a clinical condition that affects the joints. Its most common symptoms are articular cartilage loss accompanied by pain, spur formation, bone remodeling and inflammation of the joints.

    How is OA treated?

    There are several ways to address OA depending on the extent of pain, disability and the impact on function.

    Non-pharmacological treatments of OA include exercise, weight loss, bracing, shoe and insole modification, localized cold/heat, acupuncture and a well-guided physical therapy program.  In addition, various substances, such as corticosteroids, viscosupplements and blood-derived products may be administered through intra-articular injection (joint injection) to increase joint viscoelasticity and to improve pain management.

    Pharmacologically, medications can be prescribed to help with inflammation, pain and to alter progression of the osteoarthritic process.

    Advanced cases may benefit from surgical intervention including minimally invasive, outpatient procedures and for severe cases, joint replacement surgery.

    How do corticosteroids help OA?

    Corticosteroids help to reduce joint inflammation and are a quick but short-acting treatment for OA.  For some individuals, corticosteroids are the right treatment to relieve an immediate OA flare-up. Corticosteroids can be overused, and in that case, can contribute to loss of joint cartilage.  It is recommended that patients should not receive more than three corticosteroid injections in a single joint in a calendar year.

    What is Viscosupplementation?

    Viscosupplementation involves the injection of a gel-like medication into the joint to help lubricate the joint, facilitate motion and relieve pain. Viscosupplementation may offer a “fix” for some patients after a single injection, while others may benefit from periodic injections over time.

    What are blood-derived options for OA?

    There has been a good deal of recent publicity over the use of blood-based treatments like platelet rich plasma (PRP) or stem cells for the treatment OA.  Use of PRP or stem cells involves a blood draw of one’s own blood, and then a processing to bolster the content of the blood that is re-injected into the OA joint.  Use of blood-based products is expensive, often not reimbursed by insurance, and has not been shown to be dramatically more effective than viscosupplementation.

    What are ultrasound-guided injections?

    While it isn’t always necessary, diagnostic ultrasound is frequently utilized by physicians who wish to insure the correct placement of injectable medication.  It is important that if ultrasound is utilized the area of the body is appropriately protected with a protective barrier and a clean transduction solution is used to insure a sterile field for injection.  

    Are their risks in administering injections into the joint? What should I look for when choosing a doctor to perform joint injections?

    There are several things you should look for to insure you are receiving an injection from a competent physician.

    1. Is the office clean; in particular the counters, floor and table?
    2. Is the physician properly licensed and board certified?  Has that person received proper training in the use of injectable medication?
    3. Ask the physician when the last time was that a patient contracted an infection from an injection in his/her office. Has the office ever been closed because of recurring infections?
    4. Make sure the physician discusses all of the options and potential side effects prior to the injection.  This is particularly important with older, ill patients who may have a pre-existing condition that may make certain injections riskier.  If the physician is offering a blood-drawn injection, has he/she discussed cost and insurance coverage for the procedure? Some injections, like PRP or stem cells, may not be covered by insurance, and include a significant out-of-pocket payment.
    5. Ensure that the physician is using a clean syringe and needle from sterile packaging. Watch that person remove it from the packaging.
    6. Make sure the injected area is properly cleaned with a sterile cleaning solution prior to the injection.
    7. If ultrasound guidance is utilized, make sure the applicator head is covered with a sterile covering and clean gel is utilized.
    8. Patients should be alert for potential signs of infection which include:
      • increase in redness, swelling, temperature and pain at the injection site.

    It is a patient’s right to refuse the injection if he/she does not feel comfortable. It is a voluntary procedure, not a mandatory one.

    Are there side effects with OA treatment? How do I know what treatment is right for me?

    Not all treatment options are right for each patient. The physician should discuss all of the options with you, potential side effects and expected effectiveness prior to your receiving an injection.

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