Steroid Injection for Knee Joint Osteoarthritis

Osteoarthritis (OA), often referred to as ‘wear-and-tear’ or ‘degenerative joint disease’, is a condition in which the surfaces within your joints become damaged so the joint doesn’t move as smoothly as it should. As the cartilage degenerates, the space between the joint narrows and the bones begin grinding against each other. Osteophytes (bony spurs) may form which can then create more friction in the joint.

Knee -OA

Causes

As part of normal life, your joints are exposed to a constant low level of damage. In most cases, your body repairs itself and you do not experience any symptoms. Almost everyone will eventually develop some degree of osteoarthritis. One common myth is that exercise like running will “wear out your knees”. In actual fact, research shows that people who run recreationally are less likely to develop arthritis in the knee than someone who is mostly sedentary (Alentorn-Geli et al, 2017).
However, several factors increase the risk of developing significant arthritis.

Risk factors include:

  • Age. Osteoarthritis usually starts from the late 40s onwards (Blagojevic et al, 2010). This could be due to the weakening of the muscles, the body being less able to heal itself and the gradual wearing out of the joint with time. A study found that 33% of individuals older than 75 years have symptomatic and radiographic signs of knee osteoarthritis (Katz et al, 2021).
  • Obesity. Weight increases the pressure in all the joints and greatly increases your risk of developing osteoarthritis (Katz et al, 2021). One pound of body weight results in 4 pounds of pressure on the knee joint (Messier et al, 2006).
  • Gender. Osteoarthritis in the knee is twice as likely in women than men. (Blagojevic et al, 2010).
  • Genetics. Studies have found that those with a family history of knee osteoarthritis have an increased risk of developing osteoarthritis (Katz et al, 2021).
  • Joint Injury.  Injuries to the knee such as a torn meniscus or ligament injury can increase the risk of developing knee osteoarthritis in later life (Katz et al, 2021).
  • Muscle weakness and joint laxity has been found to increase risk of symptomatic knee osteoarthritis (Zhang et al, 2010). A recent review found that knee extensor weakness increases risk of symptomatic knee osteoarthritis in men and women (Oiestead, B.E et al, 2021).
  • Sedentary lifestyle has been found to be a risk for developing osteoarthritis (Katz et al, 2021). Those with knee osteoarthritis spent two-thirds of their daily time in sedentary behaviour (Lee at al, 2015).

Symptoms of knee joint osteoarthritis

  • Pain. Often described as a deep dull ache which is hard to locate. It tends to affect walking, kneeling and certain exercises.
  • Stiffness. Sometimes, you may feel stiffness in the knee at certain times, often in the morning or after a period of rest.
  • Creaking or grinding sensation when the joint moves.
  • Swelling. You may notice hard swelling (caused by osteophytes) or soft swelling (caused by extra fluid in the joint).

Anatomy

The knee is made up of two joints – the tibiofemoral joint and the patellofemoral joint. The tibiofemoral joint is a hinge joint and formed by the tibia (shin bone) and femur (thigh bone). The patellofemoral joint is formed between the femur (thigh bone) and the patella (knee cap). The ends of the bones are covered with articular cartilage, which acts as a protective coating and creates a lubrication which allows for smooth movement.

The tibiofemoral joint is the weight bearing component of the knee. On top of the tibia there are 2 semi-circular cartilage structures called the menisci. The menisci provides shock absorption, improved congruency and reduces friction during flexion and extension of the knee.

The patellofemoral joint acts as a pulley for the quadriceps muscle and thus allows more efficient knee extension and increased quadriceps power.

Knee Anatomy
Osteoarthritis (OA), often referred to as ‘wear-and-tear’ or ‘degenerative joint disease’, is a condition in which the surfaces within your joints become damaged so the joint doesn’t move as smoothly as it should. As the cartilage degenerates, the space between the joint narrows and the bones begin grinding against each other. Osteophytes (bony spurs) may form which can then create more friction in the joint.

How to diagnose

One of our highly skilled physiotherapists will ask a series of questions and perform a physical examination to help develop a diagnosis.

An X-RAY can be used to assess the stage of arthritis – if it is mild, moderate or severe. It is important to note that the severity of arthritis found on the XRAY does not always correlate to the level of pain.

Stages of Knee OA

Treatment

A knee replacement is not the only option when treating knee osteoarthritis.

Osteoarthritis of the knee joint can be well managed with conservative treatment and not require surgical intervention. Although it is not possible to reverse the degenerative changes, it is possible to reduce pain, improve strength and function.

Physiotherapy
The muscles surrounding your knee joint are like scaffolding. Strengthening the muscles around your knee can help stabilise and protect the joint. It’s also been shown to reduce pain and will prevent your knee giving way and therefore reducing the tendency to fall (Hunter et al 2009).

Aerobic exercise can reduce pain by stimulating the release of pain-relieving hormones called endorphins (Tanaka et al, 2013). It can also help you sleep easier, which is important for general health and well-being.
Our physiotherapists can advise on the best exercises to help build strength and fitness, whilst addressing each individual’s needs. It is important to have the right balance between rest and exercise, as too much activity can increase pain, whilst too little can cause the joints to stiffen up and deteriorate further.

Weight Management
Being overweight increases your risk of developing osteoarthritis and also makes it more likely the arthritis will get worse over time. When you walk, run or go up and down stairs the knee can take up to three to six times your body weight (Costigan et al, 2002). Therefore, even losing a small amount of weight can have a big difference to the strain on your knees. If you need to lose weight, you should follow a balanced, reduced-calorie diet combined with regular exercise.

Other ways you can help manage your pain

  • Pace activities.
  • Wear low-heeled shoes with soft, thick soles (such as trainers).
  • Avoid keeping your knee still in a bent position for too long.
  • Speak to your pharmacist about taking over the counter pain relief such as paracetamol or ibuprofen

Knee Osteoarthritis Steroid Injection therapy

If symptoms do not improve with conservative treatment or if the pain is affecting your sleep, stopping you from performing everyday activities such as walking or is limiting you from performing your physiotherapy exercises, injection therapy may be beneficial for you.

Injection therapy has been proven to be an effective treatment for reducing joint pain. Current evidence found that injections performed under ultrasound guidance are more accurate and more effective at reducing pain and improving function than landmark guided injections (Daniels et al, 2018).

Ultrasound-guided corticosteroid injection
Steroid injections use a small dose of corticosteroid (a strong anti-inflammatory drug) and are injected under ultrasound-guidance into the knee joint. Ultrasound guided steroid injections can be very effective for reducing knee joint pain and inflammation. As a result, this improves function, allows better exercise tolerance and delays the need for surgery.

Ultrasound-guided hyaluronic acid injection
Hyaluronic acid (HA) is a gel-like substance that is naturally present throughout the human body and provides lubrication to eliminate friction of the joints. Injecting HA can help improve lubrication and shock absorption of the knee joint as well as reducing pain and inflammation.

Ultrasound-guided Platelet Rich Plasma (PRP) injection
PRP has become increasingly popular in the treatment of Osteoarthritic joints especially the knee. It involves taking your own blood, usually from a vein in your arm and then using a centrifuge to separate the blood constituents. We then extract the plasma from the separated blood which has up to 5 x the number of platelets and growth factors which are a key ingredient in tissue regeneration. This is then injected into the knee joint. It is popular as it does not involve any drugs and is using your own bodies cells to reduce symptoms which can last up to 1 year.

If you are experiencing knee pain and want to find out what is causing your symptoms, please get in touch and one of the team will assess, diagnose and advise on the best treatment option for you. Please contact us on 0207 636 5774 or email reception@oxfordcircusphysio.co.uk

References

Alenton-Geli, E., Samuelsson, K., Musahl, V., Green, C.L., Bhandari, M. and Karlsson, J. (2017) The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis.Journal of Orthopaedic and Sports Physical Therapy. 47(6). Pp.373-390.

Blagojevic, M., Jinks, C., Jeffery, A. and Jordan. K.P. (2009) Risk factor for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 18(1) pp.24-33.

Costigan, P.A., Deluzio, K.J. and Wys, U.P. (2002) Knee and hip kinetics during normal stair climbing. Gait Posture. 16(1) pp. 31-37.

Daniels, E.W., Cole, D., Jacobs, B. and Phillips, S.F., 2018. Existing Evidence on Ultrasound-Guided Injections in Sports Medicine. Los Angeles, CA: SAGE Publications.

Hunter, D.J. and Bierma-Zeinstra,S. (2019) Osteoarthritis. The Lancet. 39 (10182). pp.1745-1759.

Katz, J.N., Arant, K.R. and Loeser, R.F. (2021. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A review. Journal of the American Medical Association. 325 (6). pp.568-578.

Kim, C., Linsenmeyer KD., Vlad, S.C, Guermaxi, A., Clancy, M., Niu, J. and Felson, D.T. (2014) Prevalence of radiographic and symptomatic hip osteoarthritis in an urbal United States community: the Framingham osteoarthritis study. Arthritis Rheumatology. 66(11). pp . 3013-3017.

Lee, J., Rowland, W.C., Ehrlich-Jones, L., Kwoh, C.K., Nevitt, M., Semanik, P.A., Sharma, L., Sohn, M-W. Song, J. and Dunlop, D.D. (2015) Sedentary behaviour and physical function: objective evidence from Osteoarthritis Initiative. Arthritis care and research. 67(3) . pp. 366-373.

Messier, S.P., Gutekunst, D.J., David, C. and De Vita, P. (2005) Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis and Rheumatism. 52(7) pp. 2026-2032.

Oiestad, B.E., Juhl, C., Culvenor, A.G., Berg, B. and Thorlund, J.B. (2021) Knee extensor muscle weakness is a risk factor for the development of knee osteoarthritis: an updated systematic review and meta-analysis including 46,819 men and women. British journal of sports medicine. 56(1). pp .349-355.
Tanaka, R., Ozawa, J., Kito, N. and Moriyama, H. (2013) Efficacy of strengthening or aerobic exercise on pain relief in peopl with knee osteoarthritis: a systematic review and meta-analysis of randomised controlled trials. Clinical rehabalitation. 27(12).pp.1059-1071.

Zhang, Y. and Jordan, J.M.(2010) Epidemiology of osteoarthritis. Clinics in Geriatric Medicine. 26(3) pp. 355-369.