Injections into the joint for arthrosis of the knee joint: injections and drugs, price in Moscow

Constant pain in the joint makes habitual activities unbearable. Many people are looking for a way to alleviate their condition every day. Ointments, creams, physiotherapy give temporary peace of mind. Orthopedists and rheumatologists often recommend targeted action - injecting drugs directly into the joint. For this purpose, various medications are used today. If you are offered intra-articular injections, first figure out what exactly you will be injected with and how this drug works.

In case of arthrosis, you need to act deliberately

Advantages and disadvantages

Among the advantages of such injections, the quick effect should be highlighted. Pain relief occurs immediately after administration and the person feels much lighter. And the drug immediately gets to the damaged area in the joint.

Disadvantages include individual intolerance to drugs and the likelihood of infection in the joint during the procedure.

The interval between injections for arthrosis of the knee joint is from 3 to 10 days, and the course of treatment can include from 1 to 5 injections, depending on the stage of the disease.

What drugs are injected into the joint and for what purpose?

Corticosteroids.

If the pain is severe and accompanied by inflammation, the joint is treated with hormonal drugs based on corticosteroids. Medicines eliminate pain and swelling, improve joint mobility for a period of up to 2-3 months. Such injections cannot be performed often, so they are considered as a first aid remedy.

Chondroprotectors.

Chondroitin and glucosamine as part of chondroprotectors are involved in the regeneration of cartilage tissue, which always suffers with arthrosis. To avoid taking pills for months, you can take a course of five injections and get faster results. Metabolism will improve, the production of your own collagen and the healing of microtraumas will accelerate.

"Alflutop" is the most popular chondroprotector in the form of injections

Synovial fluid prostheses.

With arthrosis in the joint, the amount of synovial fluid, which performs shock-absorbing and lubricating functions, is reduced. It also becomes less viscous and less elastic, and does not cope with its tasks, so the cartilaginous surfaces begin to rub and become damaged.

Synovial fluid prostheses restore its deficiency. There are medications based on hyaluronic acid that are quickly broken down by enzymes and eliminated within a few months. There are also synthetic drugs, for example Noltrexin, with a very high molecular weight and tightly cross-linked molecules, which remains in the joint for up to two years. What kind of drug it will be - “Synvisc”, “Fermatron” or “Noltrexin” - the choice is up to the patient.

Noltrexin lasts longer than other synovial fluid prostheses

Gas injections.

The carboxytherapy technique is used quite rarely. A course of such procedures can be offered at famous medical resorts that specialize in the treatment of arthrosis of the hip, knee, elbow or shoulder. Carbon dioxide is injected into the joint, the body regards this as a lack of oxygen. The joint receives additional blood flow, and its metabolism is activated. Carbon dioxide is easily removed after a few minutes, but it has already served its purpose!

Plasma therapy.

This method is quite expensive, but also cannot completely cure arthrosis. Blood is taken from the patient and platelet-rich plasma is separated from it. Own plasma injected into the joint is well accepted by the body and does not cause rejection reactions or allergies. The course of treatment includes 5-7 injections at intervals of 3-7 days, then preventive injections are given.

Plasma therapy is an expensive injection that is inferior in effectiveness to synovial fluid prostheses.

Prices for intra-articular injections

Services	Price	Sign up
Ankle joint	1500 rub.	Sign up
Knee-joint	1500 rub.	Sign up
Elbow joint	1500 rub.	Sign up
Wrist joint	1500 rub.	Sign up
Shoulder joint	1500 rub.	Sign up
Hip joint	2000 rub	Sign up

Types of blockades

Local: the injection is made directly into or around the source of pain, directly into the area of inflammation.
Segmental: blockades that inject into different segments of the spine, for example, the lumbar region. Such injections are also called paravertebral. By injecting the drug into any area, you can influence the corresponding area of the spine and nerve roots.

Why are blockades dangerous?

Complications occur in 0.5% of cases. These are unexpected reactions to medications such as dizziness, vomiting, or increased heart rate. Damage to blood vessels at the injection point with the formation of a hematoma, infection and bleeding is also possible. Allergic reactions are possible.

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Injections of hyaluronic acid into the joint

If you feel stiffness in your movements in the morning or severe pain in the joint, you should urgently see a doctor who will conduct an examination. Treatment in this case is necessary. At home, it is better not to experiment, but to immediately seek help from specialists.

It is important to understand that arthrosis cannot be completely cured, since the disease is irreversible. You can only slow down its development.

Hyaluronic acid injections are considered one of the most effective methods, and this has been repeatedly proven through many clinical studies.

How does this treatment affect the joints?

Hyaluronic acid is important for human organs because it is a component of them. Thanks to it, they are flexible, but at the same time quite durable. There is approximately 15 g of acid in our body, and, interestingly, every day one third of it is reconstructed.

In older people, the number of cells that can participate in the synthesis of hyaluronic acid often decreases. Due to its lack in the synovial fluid, tissue thinning occurs and wrinkles appear. This can lead to a number of diseases, for example, signs of deforming arthrosis of the joints will appear.

Hyaluronic acid acts as a conductor. Hyaline cartilage covers the articular surfaces of the joints; there are no blood vessels in this place; they are replaced by synovial fluid. Thus, it carries out all metabolic processes. The acid in the synovial fluid enters the middle of the cartilage, thereby reducing the friction force between other articular surfaces of the joint. This is what protects the joint from destruction and injury.

There is very little fluid in the joint, and with the development of various diseases, such as arthrosis, it can completely disappear from the cartilage cavity, in which case it is very easy to damage. The consequences can be different, for example, degenerative changes in the knee, severe pain or joint deformation. In this situation, it may lose its functions.

To prevent this from happening, the joint needs to be “nourished” using various methods. Injections directly into the joint are also called liquid prosthesis. Injecting hyaluronic acid into the knee will help increase its concentration in the joint, it will take on the functions of the lacking synovial fluid, promote the removal of unnecessary and toxic metabolic products, increase the mobility of the knee, and help eliminate pain in people suffering from arthrosis.

Why injections?

There are many different methods for providing acid to joints:

ointments and gels;
capsules or tablets;
solutions for intra-articular injections.

Why is the latter method the most effective and popular among doctors?

Firstly, the medicine does not make its way through the digestive system, which is why most of it is destroyed, but immediately gets to the right place in maximum concentration.

Secondly, this method has been proven to be the most effective; the effect in other dosage forms has not been scientifically studied.

When is it better to start a course of treatment, the most effective period

Hyaluronic acid can be used at all stages. Of course, the greatest effect will be in the first and second stages of a disease such as knee arthrosis

, when the cartilage is not yet completely destroyed and there is something to restore. At the third stage of the disease, this is not effective, there will only be a short-term effect, because the cartilage tissue is no longer there and there is nothing to restore, in this case the patient can only be helped by surgical intervention, namely knee replacement.

Contraindications and side effects

It is prohibited to administer the medicine in the following cases:

the patient is allergic to the drug;
the integrity of the skin at the injection site is compromised;
there is a rash;
if there is an active inflammatory process;
childhood and pregnancy;
in case of acute infectious disease;
if you have blood diseases;
elevated temperature;
the presence of a mental illness.

Injections with hyaluronic acid are usually easily accepted by the body, provided that the procedure is performed correctly. But sometimes complications and side effects appear:

pain in soft tissues at the injection site due to damage from the needle;
allergic reaction;
feeling of itching, burning, swelling at the injection site;
development of hemarthrosis due to bleeding.

Features of the use of solutions for intra-articular injections

Need to remember! All preparations with hyaluronic acid are quickly destroyed in the joint if there is an inflammatory process. Therefore, the injection is ineffective in case of exacerbation of arthrosis with signs of reactive synovitis. Injections should be given only in the remission stage of gonarthrosis.

From all of the above, we can conclude that it is impossible to quickly get rid of pain and inflammation in this way, but a course of injections will greatly improve the function of the joint, slow down the progression of arthrosis and reduce the number of possible pathologies, which will significantly alleviate the patient’s condition. It is important to understand that injections with hyaluronic acid work for the long term, and not for an immediate result.

Clinical studies have shown that the administration of the drug helps to delay the necessary surgery, and often avoid it.

If the injections are performed correctly, they are painless and are not accompanied by side effects, but you must follow all the doctor’s recommendations.

The course consists of 3-4 injections into each joint, the minimum interval between injections is 1-2 weeks.
You can repeat the course only after 1-1.5 years. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Are there any contraindications for plasma therapy?

This method is contraindicated for:

malignant and fast-growing benign tumors – tumor growth is stimulated;
autoimmune diseases – the immune system is stimulated, autoimmune processes can worsen;
any diseases accompanied by blood clotting disorders, including low platelet levels in the blood plasma (thrombocytopenia);
anemia;
pregnancy;
allergic reactions to blood preservatives;
acute general infectious processes;
acute local infectious processes at the site of the proposed intra-articular injection.

Injection methods for the treatment of deforming arthrosis

The head of the clinic, Candidate of Medical Sciences, Ivan Mikhailovich Bizmenov, talks about modern methods of treating osteoarthritis of large joints.

In the modern realities of domestic medicine, it is impossible to be a narrow specialist while working in an outpatient setting. We need to constantly improve, gaining the necessary knowledge, experience and skills to treat the diseases with which patients come to us. Every day I see people who complain of pain in their legs. Unfortunately, patients often come to the doctor when the pain becomes unbearable and painkillers no longer help. In such a state, it does not matter to a person what caused the pain, the main thing for him is to recover, and the sooner the better.

The doctor has a different approach: before starting treatment, he must make the correct diagnosis, find out what is the cause of the disease.

Most often, excruciating pain in the legs that worsens at night occurs due to varicose veins.

veins
In second place are atherosclerotic
lesions of the main arteries of the legs and, of course,
destructive-dystrophic
diseases of the joints along with pathology of the lumbosacral region. It is possible to cope with these diseases only with an integrated approach, with an exact clarification of how they arose and proceeded, with a full diagnosis and the most effective treatment. And this is, first of all, teamwork in a close connection “doctor – patient”, in which each member of this team must work.

Many different articles have been written about the treatment of varicose veins and atherosclerosis, various effective, low-traumatic techniques are carried out, but with the treatment of joints, not everything is so simple and unambiguous. I suggest you understand the current trends in the treatment of destructive-dystrophic, otherwise destructive-debilitating, joint diseases. But before moving on to treatment, a few words about the disease.

So, deforming arthrosis

(osteoarthritis, arthrosis, gonarthrosis, osteoarthrosis, deforming osteoarthritis) is a destructive-dystrophic disease that affects articular cartilage and other soft tissues of the joint and periarticular formations. Deforming arthrosis can occur in any human joint; the disease is characterized by a long course with exacerbations and progression, as well as severe pain. Arthrosis often affects the knee and hip joints.

In medical terms, the disease is caused by the action of biological and mechanical factors that destabilize the process of renewal of cartilage and bone tissue in the joints. Simply it is wear and tear of the articular cartilage.

The basis for the development of the disease is dystrophy

articular cartilage, associated with a lack of basic substances in the cartilage tissue - proteoglycans.

Women over 35 years of age and men who have crossed the 45-year-old threshold are at risk of developing gonarthrosis.

Among the causes of the occurrence and development of deforming arthrosis, dysplasia

, that is, improper development of the joint;
violation of statics,
or hypermobility, as a result of which the axis of the limb shifts and balance is disturbed;
physical activity
causing microtrauma to the joint (a separate group of patients is people with excess body weight);

joint
inflammation
and
injury osteoporosis; metabolic disorders
(chondrocalcinosis, gout);
hereditary decrease in the resistance of cartilage
to normal loads.

Deforming arthrosis is accompanied by disturbances of arterial and venous circulation and blood microcirculation. This in turn leads to capillary stasis

(circulatory arrest) and, as a consequence, hypoxia, that is, lack of oxygen in cells and tissues. That is why, in case of disease of large main vessels - arteries and veins, treatment begins with correction of blood circulation: varicose veins are removed, arteries affected by atherosclerosis are “cleaned”.

How PRP therapy can help with osteoarthritis

PRP therapy (plasma therapy) is a modern treatment method based on the use of the restorative properties of blood platelets - platelets. The patient's own blood plasma, enriched with platelets, is injected into the area of the pathological focus.

These properties of platelets first became known about 50 years ago. But the method found active application in medical practice later. It was first used only in sports medicine and plastic surgery, and then in other areas of medicine. Plasma therapy is especially effective in the treatment of diseases of the musculoskeletal system.

Under the influence of platelet growth factors (compounds that can stimulate cell growth):

new small arteries are formed in the articular area, tissue nutrition improves, including nutrition of the synovial membrane;
the synovial membrane restores its functions and produces an additional volume of synovial fluid;
nutrients from the synovial fluid enter the cartilage cells, its restoration occurs;
regeneration of the synovial membrane and cartilaginous surface helps reduce pain; in the initial stages of arthrosis, the cartilage is completely restored and pain disappears; in the later stages, the condition of patients improves significantly.

Plasma therapy is widely used for osteoarthritis of the knee joint, especially after sports injuries. The method is considered the gold standard in sports medicine. But it is no less effective for age-related disorders.

Until recently, osteoarthritis of the hip joint was a big problem. The disease was difficult to respond to traditional treatments. PRP of joints has significantly improved the prognosis for this type of arthrosis.

Treatment with blood plasma for ankle arthrosis allows you to completely restore its function and return to sports in the shortest possible time. In the past, ankle recovery from sports injuries took significantly longer. The method is safe and has no side effects.

Gonarthrosis of the knee joint

All of the above applies mainly to people of working age, when organic damage to the knee joint is caused by extreme circumstances and is in no way related to the aging of the body.

A completely different picture emerges when a person passes the age of 50 - when the flexibility of ligaments is lost, processes of tissue dehydration begin, and metabolism slows down.

Under these conditions, the development of gonarthrosis begins - deforming arthrosis of varying severity. In the classification accepted in medicine, gonarthrosis of the knee joint is divided into degrees I, II and III.

This disease, once it begins, progresses very quickly. Refers to acquired age-related pathologies of the musculoskeletal system. To one degree or another, it is inherent in all patients after 50 - another thing is that by leading a healthy lifestyle and avoiding extreme physical activity, the integrity of the cartilage layer in the joints can be preserved both after 70 and after 80 years.

Possible onset of the disease

Located between the tibia and femur bones, the knee joint in the human body bears perhaps one of the heaviest loads. An example would be regular running on a hard (most often asphalt) surface: each step in such running causes a shock load on the knee joint.

This joint also includes the largest sesamoid movable bone - the patella, located at the crown of the tendons of the quadriceps femoris muscle. The articular surfaces are covered with a thick, up to 2.5 mm, cartilaginous membrane consisting of chondrocytes. Medicines under the general name chondroprotectors help restore these cartilage tissue cells, which are primarily affected by gonarthrosis.

There are primary and secondary arthrosis of the knee joints. The etymology of the first is not fully understood and may have different reasons. When - from a sedentary lifestyle, and when, vice versa, from too much physical activity. Poor ecology, excess weight, and addiction to smoking or alcohol can also have an impact. Doctors consider identifying the first stage of arthrosis a great success, since the cause of the pathology is difficult to analyze.

Regular hypothermia of the feet can also provoke the onset of the disease. Therefore, it is better for people with a tendency to such diseases not to choose professions related to the cold (refrigerators, navy working in northern latitudes), etc.

In women over 45 years of age, the frequent development of gonarthrosis is associated with long-term use of contraceptives due to a decrease in the natural synthesis of estrogen. It also often occurs during menopause or under the influence of gynecological diseases such as fibroids, fibroadenomas, endometriosis, endometrial hyperplasia. Often in women, gonarthrosis is also provoked by strict diets for weight loss, during which many useful minerals and vitamins are removed from the diet.

It is much easier to decide on ways to influence secondary arthrosis, which can be a consequence of:

Defects in the development and formation of tissues;
The influence of neurodystrophic processes in the cervical and lumbar spine;
Arthritis of the knee joint;
His injuries and microtraumas;
Meniscectomy, that is, surgical removal of the meniscus;
Hormonal imbalances and endocrine chronic diseases;
Heavy and constant physical activity, including sports. To prevent joint injuries after 40 years, it is better to significantly limit and later abandon all exercises associated with extreme loads on the knee joint (in the form of running on hard surfaces or squats with a load);
Abnormal joint mobility. This condition occurs when the ligaments that hold the joint in the correct position are underdeveloped or naturally weak;
Stress and constant nervous tension.

Signs and symptoms of the onset of the disease (stage 1, or degree)

Stiffness of the knee joint in the morning;
The appearance of pain in the knee if you walk a distance of a kilometer and a half;
Pain in the joint after prolonged standing (even if without movement);
Pain in the knee even after complete rest, up to 2 hours, in a sitting position;
Pain before going to bed or in the first half of the night while sleeping.

These signs need to be paid the most serious attention, because if you do not consult a doctor during this period, the disease begins to progress rapidly, which leads to the second stage of the disease.

Gonarthrosis II degree

Which is typical:

Night pain, as well as pain in the first minutes of the morning when getting out of bed.
Pain when moving up flights of stairs.
Possibility to use public transport with restrictions.
Slightly pronounced lameness.
The occurrence of pain when moving at a distance of up to 800-1000 meters.
Limited ability for self-care.

Often, measures to simply increase the production of synovial fluid by the joint become an effective way to cure even the second degree of gonarthrosis.

Gonarthrosis degree III

Characterized by:

pain that begins immediately after rest or occurs after 500 meters of quiet movement;
severe lameness, when the help of improvised means (canes, crutches) is required;
stiffness after waking up for up to half an hour or even more;
the inability to climb stairs or enter high-level vehicles independently or without assistance;
night pain even without moving the joint.

The affected joint develops ankylosis, a condition in which the articular ends of adjacent opposing bones fuse. The leg completely loses its mobility, and the only way to return it is to replace the joint with an artificial one.

The choice of drugs and treatment methods depends not only on the degree of damage to the cartilage tissue, but also on the age of the patient, his ability to tolerate certain drugs and physiotherapeutic methods of influence.

When diagnosing, a distinction is often made between unilateral and bilateral arthrosis, and among unilateral arthrosis, right- and left-sided. The latter is often diagnosed in left-handed people.

How is the treatment carried out?

Plasma therapy for arthrosis is carried out in the form of intra-articular injections. The course will require 10 to 12 injections at weekly intervals.

Preparation for plasma therapy for arthrosis

The effectiveness of plasma therapy largely depends on the condition of the patient’s body. Therefore, before the procedure, the patient must follow the following recommendations:

do not drink alcohol for at least two weeks; the effect of alcohol is two-stage: first, the vessels dilate, and then they become persistently narrowed, which will reduce the effectiveness of therapy; The toxic effects of alcohol on the body are also important;
do not smoke - at least 24 hours, or better yet, longer; nicotine constricts blood vessels and reduces the effectiveness of treatment;
do not use medications that affect blood clotting - diclofenac, ibuprofen, nimesulide, aspirin, etc. - for at least two weeks; this will help avoid intra-articular bleeding;
Lead a healthy lifestyle, eat right, get enough sleep, avoid prolonged stress.

Plasma therapy procedure for arthrosis

PRP therapy for arthrosis begins with blood taken from the patient’s vein being filtered in a centrifuge, and since blood cells have different volumes and weights, several layers are formed in the filtrate. For injection, a concentrated suspension of platelets in the blood plasma is taken and injected into the joint cavity. The procedure is performed by a doctor experienced in intra-articular drug administration. For patients with increased sensitivity, the operation is performed under local local anesthesia. At the Paramita clinic, such services are provided only by qualified doctors with extensive experience.

After administration of platelet-rich plasma, the patient is asked to flex and straighten the limb several times to distribute the platelet suspension within the joint space.