Knee Pain

Have chronic knee pain? Do the traditional medicines no longer help? Traditional steroid injections no longer effective? Pain medicines only providing minimal relief?

SPR medicine is always looking for a more effective longer lasting solution to hopefully avoid the ultimate repair (replacement!).

Traditional steroid injections will “flush” the joint space with steroids. Steroids are a great and powerful anti-inflammatory medicine but they have significant limitations and ultimately cause damage in the long term. It is known that after just a few injections into the joint space that cartilage damage begins to occur or increase the almost always damage present.

Traditional joint injections with steroids can rapidly decrease the inflammation. Unfortunately, we know the steroids only remain within the joint space for hours following the injection. Hopefully they remain long enough to provide several weeks of relief. Each subsequent injection typically provides less effective relief with a shorter duration. Additionally, if you are diabetic, your blood sugar levels will increase substantially over the next several hours.

Zilretta is a unique formulation of a great traditional steroid that combats the issue of “wash out” from the joint space after the injection. It’s unique formulation also allows for an extended release of the steroid over weeks to months. Zilretta is a common steroid “packaged” into small spheres that slowly break down over several weeks, thus the longer duration of relief. Additionally, the spheres are “too large” to escape from the joint space after the injection. It's extremely important to ensure the medication is actually injected into the joint space. We utilize xray and xray dye to confirm we are truly in the joint! Unguided or ultrasound assistance will miss the joint up to 50% of the time!

Hyaluronic acid (“rooster comb”) injections provide a “lubrication” for the joint space. This therapy typically requires anywhere from one to five injections to provide an adequate amount of the acid to enable noticeable relief. Again, we use xray to confirm the medication is actually reaching the joint space! These injections can provide significant relief for weeks to months. Hyaluronic acid is not toxic to the joint or cartilage so this can be safely repeated.

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