Evidence based medical wellness for active people from a doc who walks the walk

Hacking the knee: what works for knee pain


I am coming clean about my knee pain.  It has been a year since the #@$%! microfracture surgery of the knee, and the knee has never hurt so much.  By the end of the day I am stiff and limping.  I finally broke down and called my orthopedic surgeon.  I don’t want more surgery, but would consider a hyaluronic acid injection.  For those not in the know, hyaluronic acid (Supartz, Synvisc, Eufflexxa, Orthovisc, etc) is a sterile viscous solution injected in to the knee to mimic the knee’s own cartilage.  Loss of cartilage is the pain causing culprit in osteoarthritis (“wear and tear” arthritis.)

But does it work? And what is the difference between the different brands? Some brands are slightly thicker than other brands, but they all work by cushioning the knee joint.  The biggest difference is the amount of injections required.  Synvisc requires a series of 3 injections, given once per week for three weeks.  Synvisc One requires only a single injection.  Pain relief can last from 6-9 months (or more!)  Supartz lasts a similar amount of time.  (As do the others.)

But does it work? Yes.  Meta-analysis of injections (a meta-analysis is a study that combines a bunch of smaller studies and looks for trends and conclusions) are positive.  In 1 -4 weeks after a hyaluronic injection, patients had significant reduction in pain and stiffness.  In general, when given correctly, the injections are safe.

Most insurance companies will cover these injections, which is good because they are expensive!

There are also other treatments out there that are not FDA approved, and therefore, not covered by insurance.

  • Stem cell transplants: in this procedure, bone marrow is extracted from your hip, spun down and then the stem cells injected in to the knee to stimulate cartilage regrowth.  My sister in law actually just paid out of pocket for this ($3000). Results can take up to 6 weeks.  It is still experimental, and there is not good data in the U.S. supporting use for this indication.  I will check in with her and report back periodically with her progress.
  • Orthokine: in this procedure, 2 ounces of blood are removed from the patient’s arm, spun down and then the middle layer is injected into the knee joint.  This middle layer contains a substances that reportedly stop inflammation, and thus knee pain after injection. This is not FDA approved.
  • Platelet Rich Plasma (PRP): blood is again removed from the patient, spun down and the platelet rich plasma is injected into the knee. Preliminary studies have shown improvements in pain. It is unclear why this may work; theories include decreased inflammation, stimulation of cartilage regrowth, and stimulation of hyaluronic acid production. There have been a fair number of trials showing safety.  Platelet Rich Plasma use is exempt from FDA regulation.

I am intrigued with the use of PRP. I think I will go the traditional route with hyaluronic acid injection, but will check with my orthopod and get his opinion too.  Anyone out there done PRP?

Author: PookieMD

I am a board certified internal medicine physician. I love medicine and seek to bring evidence based medicine to the fitness and wellness world.

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