Injection therapy

Steroid injection and Durolane injection

Injections are used in orthopaedics for 2 main reasons, one is to treat something and the other is to confirm a diagnosis. 

Diagnostic


Imagine you get home one night and turn on the lights, but no light comes on. The first thing you may suspect is a blown lightbulb, so you try a new one and see if the light works. If it still doesn't work then you might look at the fuse box, and if not that then the switch. 

Charles often uses injections in the same way. If you have a pain, and we think it is coming from a certain structure but we are not sure, then before doing anything drastic we can inject it to numb it and calm down inflammation (local anaesthetic and steroid) to see if that helps. 

Sometimes this can actually cure the problem too, or sometimes it can guide onward treatment. 

Treatment


For some conditions, an injection is done to solve the problem for good, or with the understanding that it won't last forever, but the objective is a medium-term relief. 

Types of injection


Steroid


Steroid injections are usually a mixture of numbing local anaesthetic what works for about 24 hours, and a synthetic steroid called Kenalog that lasts for several months - but is a bit variable. 

These are really good for Hoffa' syndrome where they can often be a cure as they break a vicious cycle, or for iliotibial band friction syndrome, where they get you good enough to do the right rehab. 

They are not so good for arthritis, where they run the risk of damaging the joint, and only mask the problems for a few months before wearing off. 

They are cheap and are still widely used by GPs and the NHS for arthritis pain, but Charles is not keen in this as he sees quite a few cases where these have caused terrible infection needing surgery,  and then joint replacement can't be done for a long time. 

Advantages: Cheap, available on the NHS, good for the right conditions.

Disadvantages: Risk of infection, may just mask the problem (eg arthritis), the risk of flare up, should not have a joint replacement for the next 6 months.

Durolane


This is a brand of viscosupplement (there are a variety of brands). Think of it like an oil change for a worn out joint, or artificial joint lubrication. These expensive injections are not like steroid and are a treatment for early arthritis which Charles prefers. He has had them himself and had a great result. Lots of people report a year or more of benefit when it is used in the right person at the right time. However, sometimes they seem to have little effect and can be a waste of time and money! Overall about 70% of people are really pleased with these. They also seem to be safer than steroid injections in terms of the risk of infection and joint replacement soon after.

Advantages: Smaller risk of infection, good for arthritis, long-lasting if it works, not worried about a later joint replacement.

Disadvantages:   Not cheap (but all insurers do cover it), not available on the NHS,  risk of flare up.

What is is like having an injection? 


This usually happens in a usual consultation time of 20 minutes and you can walk out and drive home as usual. Charles will talk you through it, clean your skin very thoroughly, clean his hands very thoroughly, get the injection ready with a little children's needle, carefully place the injection to the exact right spot and put a plaster on. 
The needle is smaller than a blood test needle and should be less painful than that. Nearly everyone is a bit nervous before but says afterwards that it was way better than they had expected! 

What are the risks? 


Either type of injection has a very very small risk of infection, it is more with steroid into the joint, which is why Charles usually won't put steroid in the joint itself (as opposed to the fat pad or ITB). 
There is a chance of a flare-up - being more sore for the next few days before feeling the benefit.
There is a chance it does not help.
There can be rare problems such as permanent skin whitening, or permanent change in the contour of the fat under the skin leaving a little dimple. These are rare with steroid and very very rare with Durolane. 

What can I do afterwards? 


There are no rules! Do what you feel able and go purely by feel.


"Charles, the [Durolane] injection you gave me has been excellent for about 15 months now and I have been much walking better, it is beginning to wear off now and I'm really keen for another one to avoid the need for an operation" RH