Side Effects Of Injection Therapies
Side effects include a very low risk of infection and pain at the injection site. You also must stop taking oral anti-inflammatory medications for a short amount of time if you get a PRP injection, Dr. Genin says.
Often, many of these injections are effective in reducing or stopping your joint pain, but its important to remember that they may not keep the pain from returning, Dr. King notes. In fact, theyre most effective when used with other therapies. And we consider surgical options only if other treatment options have failed.
Epidural Fat Graft During Lumbar Decompression Laminectomy/discectomy
Epidural fat grafts have been used to prevent epidural and perineural fibroses. In a case series study, Martin-Ferrer reported failure of autologous fat grafts to prevent post-operative epidural fibrosis in surgery of the lumbar spine in 3 patients. Hypertrophic epidural scarring occurred in these 3 cases despite the presence of autologous fat grafts. Histopathological examination of the fat removed from 2 patients who were operated on a second time showed a fibrotic infiltration into the fat graft. One randomized study found no reduction in fibrosis with use of epidural fat graft in lumbar laminectomy and discectomy. A non-randomized comparative study found no improvement in long-term outcomes with use of epidural fat grafts in lumbar disc surgery. Moreover, there were reports of cauda equina syndrome following hemi-ilaminectomy and discectomy for lumbar disc herniation. Computed tomography-scan revealed the migration of the free fat graft used for preventing peridural scar formation and removal of the graft resulted in patients’ recovery .
Repeated Courses Of Treatment With Hyaluronic Acid Are Safe And Are Associated With The Delay Of Total Knee Replacement For Up To 3 Years
A July 2018 study in the American Journal of Orthopedics recognized that for some people: Total knee replacement is a significant procedure with potential risk for serious complications and high costs. Alternative lower risk therapies that can delay or total knee replacement are valuable to those who are poor candidates for surgery or wish to avoid total knee replacement as long as possible.
Are Hyaluronic Acid Injections the answer? Here is what the study concluded:Repeated courses of treatment with Hyaluronic Acid are safe and are associated with the delay of total knee replacement for up to 3 years. So again, we have a three-year delay after repeated courses of Hyaluronic Acid injections supported in the research. But what about the study that says Hyaluronic Acid Injections that delay inevitable knee replacement are a waste of time, money, and resources?
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Why Choose Rooster Comb Injections Over Other Injection Types
Dr. Saenz Response: Traditionally the other injection would have been a steroid, cortisone.
Cortisone injections do have a role in the management of osteoarthritis. But its effects are going to go over a definable period. It’s used as a method of putting out the fire, so to speak, of osteoarthritis. These injections are used for treating those individuals that are in an osteoarthritis flare. However, this isnt expected to produce long-term benefits.
Viscosupplements, like the rooster comb injections, work differently. They work at rejuvenating what is referred to as the synovial fluid. Synovial fluid is the natural lubricant that we have in our joint that reduces friction. So that is how hyaluronic acid or rooster comb injections work. They rejuvenate and restore the volume and viscosity of someone’s synovial fluid.
Viscosupplementation For Muscle Stiffness/spastic Hemiparesis
Mayer presented 2 recent articles that propose novel interventions for treating spastic hemiparesis by changing biological infrastructure. In 18 patients with unilateral spastic arm paralysis due to chronic cerebral injury of greater than 5 years’ duration, Zheng et al transferred the C7 nerve from the non-paralyzed side to the side of the arm that was paralyzed. Over a follow-up period of 12 months, they found greater improvement in function and a reduction of spasticity compared to rehabilitation alone. Using functional magnetic resonance imaging , they also found evidence for physiological connectivity between the ipsilateral cerebral hemisphere and the paralyzed hand. In the 2nd article, Raghavan et al examined the concept of stiffness, a common symptom in patients with spastic hemiparesis, as a physical change in the infras-tructure of muscle. Raghavan’s non-neural hyaluronan hypothesis postulated that an accumulation of hyaluronan within spastic muscles promotes the development of muscle stiffness in patients with an upper motor neuron syndrome . In a case series of 20 patients with spastic hemiparesis, Raghavan et al reported that upper limb intra-muscular injections of hyaluronidase increased passive and active joint movement and reduced muscle stiffness. The author concluded that interventions that change biological infra-structure in UMNS is a paradigm on the horizon that bears watching.
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When Prp Doesnt Work It Is Usually Not The Solution Used During Treatment But How The Treatment Itself Is Given
In the Journal of Knee Surgery, doctors at the Division of Sports Medicine, Department of Orthopedics, at Rush University Medical Center in Chicago wrote:
- Traditionally, treatment options have included lifestyle modifications, pain management, and corticosteroid injections, with joint replacement reserved for those who have exhausted nonsurgical measures.
- More recently, hyaluronic acid micronized dehydrated human amniotic/chorionic membrane tissue, and platelet-rich plasma injections have started to gain traction.
- PRP has been shown to have both anti-inflammatory effects through growth factors and stimulatory effects on mesenchymal stem cells and fibroblasts .
- Multiple studies have indicated that PRP is superior to hyaluronic acid and corticosteroids in terms of improving patient-reported pain and functionality scores.
- Unfortunately, there are many variations in PRP preparation, and lack of standardization is a factor.
Cms Takes A Second Look At Ha Knee Injections
Could CMS be preparing to change its coverage policy for HA injections in the knee?
On December 15, 2014, CMS partner agency, the Agency for Healthcare Research and Quality Technology Assessment program, issued an assessment report of HA of the Knee.”)and appeared to set the stage for second look at CMS national coverage policy for HA.
The AHRQ report said, essentially, that HAs ability to improve knee function, patient quality of life or the likelihood of a future knee replacement surgery was difficult to prove. In fact, said AHRQ, the evidence available was inconclusive.
Program develops systematic reviews, health technology assessments, and other reports at the request of the Centers for Medicare & Medicaid Services Coverage and Analysis Group. These reports are used to inform Medicares national coverage policies.)
The report, which will be taken OFF the AHRQ website in a couple of weeks , will be available on Orthopedics This Week at for as long as necessary.
Why This Initiative to Re-Visit HA Coverage?
Orthopedic and pain physicians have been using visco-supplementation for decades. They use it to treat pain and stiffness arising from osteoarthritis of the joints. CMS and every major payer have been reimbursing these physicians for using visco-supplementation since the 1990s.
Here is what CMS said as they were announcing this new initiative:
Therefore:
Almost.
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Not All Hyaluronic Acid Products Are Created Equal
Two types of HA are used in intra-articular knee injections: one is derived from rooster combs, while the other is created in the lab using a process that involves bacterial formation. This is important to know if you happen to be allergic to avian products such as feathers, eggs, or poultry, in which case you could have a serious allergic reaction to any of the hyaluronic acid brands made from rooster combs.
There are eight brands of hyaluronic acid approved by the FDA for treating knee osteoarthritis. Besides how they’re made, each differs in how it’s administered and how quickly it tends to bring relief. According to the manufacturers, all are effective for up to six months.
| Comparison of Hyaluronic Acid Injections |
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- Itching
- Bruising
These tend to be temporary and mild. You can reduce the chances of experiencing side effects by avoiding strenuous activities and resting your knee for the first 48 hours following your injection.
Neither type of hyaluronic acid injections are considered safe for children, pregnant women, and nursing mothers. It’s important that your healthcare provider has your complete medical history before they suggest or administer hyaluronic acid to treat knee OA.
How Do Hyalgan And Synvisc Treat Arthritis
Both Hyalgan and Synvisc offer temporary pain relief for OA. They donât repair cartilage or reverse bone damage from arthritis. But you can use them to help you move more easily with less pain. They may make daily activities or exercise more comfortable for you.
Hyaluronic acid injections may also help you delay knee replacement surgery if you arenât ready for it yet. They may also be a pain-relief option if other treatments, like acetaminophen, nonsteroidal anti-inflammatory drugs , steroid shots, physical therapy, losing weight, heat and ice treatments, or using a cane to walk havenât worked.
You can take Hyalgan and Synvisc if you choose to continue to use these treatments.
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Intramuscular Steroid Injection For The Treatment Of Neck Pain
In a meta-analysis, Nouged and colleagues examined the effectiveness of local anesthetic trigger-point injections in adults with myofascial pain syndrome in the head, neck, and shoulder regions compared to dry needling, placebo, and other interventions RCTs using local anesthetic injections in adults diagnosed with MPS were included, and searches were conducted in the Cochrane Library, Medline via PubMed, Web of Science and Embase. The initial search strategy yielded 324 unduplicated references up to April 1, 2018. A total of 15 RCTs were included, with 884 adult patients diagnosed with MPS. Meta-analysis showed a significant improvement in VAS pain scale of 1.585 units at 1 to 4 weeks in the local anesthetic group compared to the dry needling group . However, when only including double-blinded studies, the effect was not statistically significant . There was also a significant improvement in pain of 0.767 units with local anesthetic at 2 to 8 weeks compared to placebo . No statistically significant differences were found in other secondary outcomes between local anesthetic and all other interventions. The authors concluded that although local anesthetics provided a significant improvement in pain compared to dry needling, evidence was of low quality, and sensitivity analyses including only double-blinded studies provided no statistically significant difference, and that additional studies are needed to confirm these findings.
Caring Medical Research Case Studies
Our research team has published research on patient outcomes and case studies using bone marrow aspirate. Here is a sample of those outcomes. Again, we must remind you that this treatment does not work for everyone. Unfortunately, if you are reading this article you are probably very attuned to medical treatments that do not work.
In the medical journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, our Caring Medical research team published our findings in seven patients. The patients who were treated for knee pain are featured below:
Patient case Knee pain: A 69-year-old man
A 69-year-old male came into our office with pain in both knees, with his right knee significantly more painful. Pain resulted in frequent sleep interruption and limitation of exercise.
The patient had received prolotherapy at another office in the previous two years but felt that the treatment has reached its maximum ability to heal.
The patient was diagnosed with osteoarthritis and received five bone marrow/dextrose treatments in each knee at two-month intervals.
- Two months after the final treatment, the patient reported that he was completely free of pain or stiffness in both knees, had regained full range of motion, no longer suffered sleep interruption, and was no longer limited in exercise or daily life activities.
Patient case Knee pain A 56-year-old woman
The patient received bone marrow/dextrose treatments for six visits with 810 week intervals.
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Anterior Lumbar Interbody Fusion For Degenerative Disk Disease / Back Pain
The authors stated that disadvantages of the ALIF technique include approach-related complications such as retrograde ejaculation, visceral and vascular injury. They also noted that there were multiple limitations in this systematic review. Some studies reported ALIF and TLIF combined with posterolateral fusion, thus skewing the potential fusion results and outcomes. Furthermore, studies revealed a heterogeneous patient population, with different levels and pathologies reported that impacted radiological fusion rates and clinical outcomes thus, the conclusions could not be made regarding the effects of different levels and pathologies on clinical outcomes. These researchers stated that ALIF, TLIF and PLIF remain the more commonly performed techniques for LIF LLIF has established its place as a robust technique for deformity correction and interbody fusion, with OLIF requiring further studies and data to establish its place. Moreover, these researchers also stated that available data suggested that anterior techniques are superior to posterior in terms of disc height restoration, lumbar lordosis and deformity correction, and that clinical outcomes and fusion rates were similar to those in posterior techniques however, these data were based on heterogeneous studies with multiple indications and therefore comparison was difficult to make.
Bluewave Insurance Is Here To Help
So, does Medicare cover for knee gel injections? Yes, Original Medicare does pay for knee gel injections. However, that doesnt mean that everyone with Medicare coverage qualifies.
You will still need to show proof that you have osteoarthritis, and that other treatments have been ineffective. Even though Medicare covers part of the costs, you may still need help paying for drugs, deductibles, or copayments as well. This is where an MAPD or Medigap insurance plan with Bluewave Insurance can help.
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If you have any further questions about Medicare or want to learn more about cost-sharing Medigap options, call us attoday!
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What Are Hyalgan Injections
Hyalgan injections contain hyaluronic acid, which occurs naturally in the synovial fluid that cushions the joints. Osteoarthritis can cause the synovial fluid to break down, reducing joint lubrication and increasing friction. It’s not known exactly how Hyalgan injections reduce pain, but it’s thought that they help replenish the synovial fluid to ease friction and improve shock absorption.
Hyalgan injections are approved for the treatment of knee osteoarthritis, and the FDA has not approved it as a treatment for other joints so far. The treatment is generally suitable for people who have tried more conservative treatment options, such as physical therapy and painkillers, but have not achieved adequate pain relief.
A physician administers Hyalgan injections by injecting Hylagan fluid directly into the knee joint. Generally, the treatment is given as a course of between three and five injections at weekly intervals.
People receiving Hyalgan injections should avoid putting pressure on their knee joints for around 48 hours after each injection. Most people can expect reduced pain and improved mobility after three injections. How long it takes to see results depends on each person’s overall health and disease severity, and the pain relief provided by Hyalgan injections can last up to 6 months.
Research Comparing Prp Bone Marrow And Adipose
A July 2020 study published in the journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, compared platelet-rich plasma , bone marrow aspirate concentrate, and adipose-derived mesenchymal stem cell injections in the treatment of osteoarthritis of the knee using functional scores.
- Methods: A total of 89 patients with painful knee osteoarthritis were included in this study.
- Patients were assigned to one of the 3 treatments according to the severity of osteoarthritis as indicated by symptoms and radiography to PRP , bone marrow aspirate concentrate , or adipose-derived MSC .
- Clinical assessment was performed using standard scoring systems, Surveys were completed at preoperative, and at 90, 180, and 265 days post-treatment.
Results: They all worked well.
- In a general statement, the PRP worked just as well in stage 1 knee osteoarthritis patients as the bone marrow aspirate worked in the stage 2 knee osteoarthritis patients and the adipose-derived stem cells worked for the stage 3 knee osteoarthritis patients. To quote the researchers: Our findings support previous reports and encourage further research on the use of these cost-effective treatments for osteoarthritis of the knee.
This is also a validation of our policy of not going straight to stem cell therapy in some of our patients. PRP or Prolotherapy, which is discussed below can provide equally good results without the added expense.
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What Areas Can Rooster Comb Injections Be Used
Dr. Saenz Response: Osteoarthritis of the knee isn’t really any different than that of the ankle or the shoulder. It’s a disease that affects the articular cartilage, which is the protective cartilage over the bone.
When articular cartilage becomes degraded or eroded , that is osteoarthritis. So, in a very broad sense, these rooster comb injections can be injected into any joint. We could likely expect to see the same effect.
But in truth, there is only one indication, and that is for injection of the supplements into the knee. Thats the only thing that the FDA has approved them for at this point in time.
Dr. Saenz during an exam for knee pain.
Does Medicare Cover Orthovisc Injections
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Combined Ozone Gas And Viscosupplementation For The Treatment Of Knee Osteoarthritis
Giombini et al compared short-term clinical outcomes between IA injection of HA, oxygen ozone , and the combination of both, in patients affected by OA of the knee. A total of 70 patients with knee OA were randomized to IA injections of HA , or O2O3 or combined 1 per week for 5 consecutive weeks. KOOS questionnaire and VAS, before treatment at the end , and at 2 months after treatment ended were used as outcome measures. Analysis showed a significant effect of the conditions in all parameters of the KOOS score and a significant effect of groups for pain, symptoms, activities of daily living and QOL. The combined group scores were higher compared to the HA and O2O3 groups, especially at follow-up. The authors concluded that the combination of O2O3 and HA treatment led to a significantly better outcome especially at 2-month follow-up compared to HA and O2O3 given separately to patients affected by OA of the knee. This was a relatively small study with a short-term follow-up . These preliminary findings need to be validated by well-designed studies.
