Injection therapy

Injection therapies can be a great option for many sports and knee problems. Here you can read about the various different types of injection therapy, the pros and cons and what to expect.

Mr Willis-Owen clearly has exceptional knowledge, experience and skills. But they come second, in my opinion, to his ability to treat every patient as a one-off individual. This has been borne out by the experiences of several of my friends, who have also been fortunate to come under his care. My knee replacement is a great success and at eight weeks I am back to my former very active lifestyle, but now with no pain or fear of collapse.

Different types of injections

Diagnostic versus Therapeutic

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 that works. If it still doesn’t work then you might look at the fuse box, and if not that then the switch. I often use 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. This is a diagnostic injection.

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. This is a therapeutic injection.

Types of injection

Steroid

Steroid injections are usually a mixture of numbing local anaesthetic that 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’s syndrome (fat pad impingement) 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 I am not keen on this because I see quite a few cases where these have caused terrible infection needing surgery,  and then joint replacement can’t be done for a long time. Be a bit wary of steroid injections for arthritis – there are much better options.


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 – Viscosupplement – Hyaluronic Acid

Durolane 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 are more expensive injections but they are not like steroids.

They are a treatment for early arthritis which I prefer. In fact I have had them myself 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 70-80% 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. To get good results it is important to pick the right patients to use it on. I will usually give you a likelihood of success based on your scans or X-rays. 

I do this in an ordinary 20-minute appointment and you should be fine to drive home. It can make the knee sore for the next week or so in some patients (about 1 in 10) and for this injection, if this is beginning to happen, then take anti-inflammatories for about 5 days to cover the flare-up. The peak effect is felt at six weeks so you do need to be patient with it. 

With any injection, there is a very small risk of making you worse by getting an infection. The risk seems to be higher with steroids. 


Advantages: Smaller risk of infection, good for arthritis, long-lasting if it works, not worried about a later joint replacement.
Disadvantages:   Not cheap (but insurers do cover it), not available on the NHS,  risk of a flare-up.

When it works (about 80%) – Its works well – here is some typical feedback: 

Dear Mr Willis-Owen, my Durolane injection last Thursday has been an incredible success. My knee is pain-free and no longer limping is beneficial to my thigh and hip. Thank you very much for recommending durolane and for your expertise in administering it.

These injections can be done at the Bournemouth Private Clinic and the cost is £449. It is possible to have these injections at other sites, but the cost is more if you are self-funding.

Biological injections – Platelet Rich Plasma – Arthrex ACP

These injections rely on taking some of your blood and processing it to extract all of the powerful natural factors that make us heal up when we get injured or sick. By injecting a concentrated dose of this into a joint with early arthritis we can supercharge your body’s ability to control inflammation and calm the joint down. These injections are safer as it is made from your own blood. They can provide longer-term improvement of symptoms in early arthritis. Please see the below downloadable leaflet for some further information.

I do these injections in an ordinary 20-minute appointment and you should be fine to drive home. It can make the knee sore for the next week or so in some patients (about 1 in 10) and for this injection you should try to avoid anti-inflammatories for about 6 weeks to allow it to work. The peak effect is felt at six weeks so you do need to be patient with it. 

With any injection, there is a very small risk of making you worse by getting an infection. The risk seems to be higher with steroids. 

There are scientific studies which show these are superior to steroid injections and to the visco-supplement injections meaning this is often the best option

Platelet Rich Plasma Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis: a Meta-Analysis

Comparison between intra-articular infiltrations of placebo, steroids, hyaluronic and PRP for knee osteoarthritis_ a Bayesian network meta-analysis

Advantages: Natural, uses your own healing potential, promising results

Disadvantages: Expensive, no guarantee they will work in a specific case

When it works (about 80%) – Its works well – here is some typical feedback: 

Dear Charles, Unbelievably, it’s now 6 weeks since you gave me the knee injections and my overall feeling is that of a pretty dramatic improvement, especially with regard to pain.  With the way I feel at the moment I would definitely not be coming to see you thinking that I might need knee replacement surgery, as I did in mid-September.

These injections are done exclusively at the Bournemouth Private Clinic and the cost is £600 for one knee or £1000 for both knees (if carried out in a single appointment).

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What is it like having an injection? 

An injection is typically carried out during the 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 tiny little 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 much 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 I 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. 

Mr Willis-Owen clearly has exceptional knowledge, experience and skills. But they come second, in my opinion, to his ability to treat every patient as a one-off individual. This has been borne out by the experiences of several of my friends, who have also been fortunate to come under his care. My knee replacement is a great success and at eight weeks I am back to my former very active lifestyle, but now with no pain or fear of collapse.

What can I do afterwards? 

There are no rules! I usually suggest that you take it easy for the first week, then do what you feel able. Go purely by feel.

Frequently asked questions

In the NHS GPs often do the steroid injections (the least sophisticated) but unfortunately, the viscosupplement and PRP injections are not routinely available on the NHS locally at the time of writing.

If the injection has worked well for a long period of time, but then wears off, we can repeat it. I have some patients who are on their fifth or sixth year and are quite happy managing their knee arthritis in this way, avoiding major surgery. If we do an injection and it doesn't work then there's probably no point in keep repeating it.