Are Knee Gel Injections Worth It? Benefits and Risks

Are Knee Gel Injections Worth It?

Knee gel injections, also known as viscosupplementation or hyaluronic acid injections, are a common treatment for knee osteoarthritis pain. But recent research has raised concerns that they may actually worsen knee OA over time. Here's what you need to know about the risks and benefits of knee gel injections.

What are Knee Gel Injections?

Knee gel injections contain hyaluronic acid, a thick fluid that naturally occurs in the synovial fluid around joints. The injections aim to supplement the hyaluronic acid in the knee joint that gets depleted by osteoarthritis.

The gel is injected directly into the knee joint. It acts as a lubricant and shock absorber to potentially reduce pain and improve joint mobility.

Do Knee Gel Injections Work?

Studies show hyaluronic acid knee injections can provide pain relief for up to 6 months for some osteoarthritis patients. However, results are mixed. In general, knee gel injections have been shown to:

• Reduce knee osteoarthritis pain for up to 26 weeks
• Improve joint function for up to 52 weeks
• Delay the need for knee replacement surgery

But many studies found the injections provided no greater pain relief than placebo saline injections. The effects also appear to decline after 6 months in most people.

Risks and Side Effects

Potential risks and side effects of knee gel injections include:

• Joint pain, swelling and stiffness for 1-2 days
• Joint infection
• Allergic reaction
• Skin rash or redness
• Leg numbness or weakness
• Bleeding and bruising

Do Knee Injections Worsen Osteoarthritis?

Recent studies have found that knee gel injections may actually accelerate the progression of knee osteoarthritis over 1-2 years:

• A 2018 study found the injections increased cartilage loss over 12 months compared to saline injections.
• A 2019 study found patients who got hyaluronic acid knee injections had a 5-fold increased risk of progression of osteoarthritis over 2 years.

Researchers believe the injections may have unintended effects on joint tissues, inflammation and mechanics that worsen knee OA.

Alternatives to Knee Gel Injections

Given the risks, it may be best to try these safer alternatives first:

Physical Therapy

Physical therapy aims to strengthen muscles around the knee, improve joint stability and reduce pain. Modalities like heat, ice and electrical stimulation may also be used.

Bracing

Braces redistribute weight off damaged knee joints. They also improve alignment and support joint structures.

Weight Loss

Losing excess weight reduces stress on the knees with every step. Even modest weight loss can significantly improve osteoarthritis symptoms.

Exercise

Low-impact exercises like swimming, biking and strength training improve joint flexibility and strengthen muscles for better support.

Physical Therapy

Physical therapy aims to strengthen muscles around the knee, improve joint stability and reduce pain. Modalities like heat, ice and electrical stimulation may also be used.

Over-the-Counter Pain Relievers

Oral NSAIDs like ibuprofen and naproxen can temporarily alleviate osteoarthritis pain and inflammation.

Topical Pain Relievers

Creams with menthol, capsaicin or NSAIDs may provide targeted knee pain relief with less risk of side effects compared to oral NSAIDs.

When to Consider Knee Gel Injections

Knee injections may still be an option if:

• You've tried the safer alternatives without sufficient pain relief
• You need stronger relief for a short time to remain active
• You want to delay knee replacement surgery
• Other therapies aren't possible due to health conditions

Talk to your doctor about whether you might benefit from knee gel injections. They can review the potential risks and rewards given your specific knee osteoarthritis situation.

What to Expect with Knee Gel Injections

Preparing for the Injection

Your doctor will likely recommend:

• Stopping blood thinners several days before to reduce bleeding risk
• Taking antibiotics before to prevent infection
• Arranging a ride home as you won't be able to drive after

During the Procedure

Knee injections involve:

• Numbing the injection site first for comfort
• Injecting the gel into the knee joint or surrounding area
• Using imaging guidance like ultrasound or fluoroscopy for accuracy
• Wearing a compression bandage after to prevent bleeding

Recovery Process

Expect:

• Mild knee pain, swelling and stiffness for 1-2 days
• To avoid strenuous activities for 1-2 days
• To ice and elevate the knee to minimize swelling
• Use over-the-counter medications for discomfort as needed
• It may take 4-6 weeks to experience the full effects
• Effects last around 6 months on average

The Bottom Line

Knee gel injections may provide temporary knee osteoarthritis pain relief for some people. But recent evidence suggests they may worsen knee OA progression over time. Try safer alternatives first like physical therapy, weight loss and exercise. Discuss the risks and benefits with your doctor to decide if injections are worth trying.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.