Hyaluronic Acid Injections and Rehab Tips for Osteoarthritis Relief

Hyaluronic acid injection and rehabilitation recommendations for osteoarthritis?

Hello Doctor, my mother is nearly 74 years old.
In 2015, she received hyaluronic acid injections in her right knee due to osteoarthritis, which improved her condition.
She hasn't had any special care since then and has maintained her condition until now.
However, in the past few months, she has been experiencing pain in both knees after sitting for a long time, accompanied by a cracking sound, especially in her left knee, which is quite uncomfortable.
She has been actively undergoing rehabilitation for a month, including electrical therapy and infrared treatment, but it seems to have little effect.
Currently, she has significant soreness in the back of her left knee, which worsens with walking, causing her to limp, and there is swelling that prevents her from squatting or bending.
My mother asked the doctor if she could receive hyaluronic acid injections in her left knee, but the doctor advised against it due to inflammation.
However, the doctor who treated her back then would administer injections whenever she complained of pain.
I would like to ask the doctor: 1.
What could be the cause of the soreness in the back of her left knee? 2.
Can she receive hyaluronic acid injections while experiencing pain? 3.
Should both knees be treated together, or can the left knee be treated first? 4.
Could knee issues affect the hip joint? 5.
Would you recommend continuing electrical therapy and infrared treatment, or should she proceed directly with hyaluronic acid injections? Thank you, Doctor!

Miss Huang, 70~79 year old female. Ask Date: 2023/04/23

Dr. Shi Guozheng reply Orthopedics

1.
Arthritis can cause pain.

2.
In cases of severe pain, medication treatment should be prioritized.

3.
The severity of arthritis needs to be assessed through X-rays.
If it is very severe, hyaluronic acid injections are not recommended; if it is mild, medication treatment can lead to improvement.

4.
Usually, it does not occur.

5.
During inflammation, rest, medication treatment, wearing a knee brace, and using a cane for assistance while walking are recommended.

Reply Date: 2023/04/23

More Info

Osteoarthritis (OA) is a degenerative joint disease that commonly affects older adults, leading to pain, stiffness, and reduced mobility. In your mother's case, it seems that she has been experiencing increased discomfort in her knees, particularly the left one, which is not uncommon as OA progresses. Let's address your questions one by one.

1. Possible Causes of Pain in the Back of the Left Knee: The pain your mother is experiencing in the back of her left knee could be due to several factors. It may be related to the degeneration of the cartilage in the knee joint, which can lead to inflammation of the surrounding tissues, including ligaments and tendons. Additionally, conditions such as bursitis (inflammation of the bursa), tendinitis, or even referred pain from the hip joint could contribute to her symptoms. The "clicking" sound she hears when moving her knee is often associated with the roughened surfaces of the joint due to cartilage wear.

2. Can Hyaluronic Acid Be Injected Now?: While hyaluronic acid (HA) injections can provide relief for osteoarthritis symptoms by lubricating the joint and reducing inflammation, they are typically not recommended during active inflammation. If your mother's knee is currently inflamed, it may be best to wait until the inflammation subsides before considering HA injections. This is to ensure that the injection is effective and to minimize the risk of exacerbating her symptoms.

3. Should Both Knees Be Injected or Just the Left?: If HA injections are deemed appropriate after the inflammation has resolved, the decision to inject one or both knees should be based on the severity of symptoms in each knee. If the left knee is significantly more affected, it may be reasonable to start with that knee. However, it is essential to consult with her healthcare provider to assess both knees' conditions and make an informed decision.

4. Impact of Knee Joint Issues on the Hip Joint: Yes, problems in the knee joint can indeed affect the hip joint. The body often compensates for pain or dysfunction in one joint by altering movement patterns, which can lead to increased stress on adjacent joints, including the hip. This compensation can result in hip pain or discomfort over time, as the body tries to avoid putting weight on the affected knee.

5. Should She Continue with Electrotherapy and Infrared Treatment or Go for HA Injections?: Continuing with physical therapy modalities like electrotherapy and infrared treatment can be beneficial, especially if they provide some relief. These treatments can help reduce inflammation and improve circulation, which may alleviate pain. However, if there is no noticeable improvement after a reasonable period, it may be worth discussing the potential for HA injections with her doctor once the inflammation is under control. The choice between continuing conservative treatments or opting for injections should be made collaboratively with her healthcare provider, considering her overall health, the severity of her symptoms, and her treatment goals.

In summary, your mother's situation requires careful management. It is crucial to address the inflammation first before considering HA injections. Continuing with physical therapy may provide some benefits, and it is essential to monitor her symptoms closely. Open communication with her healthcare provider will help ensure that she receives the most appropriate care tailored to her needs.

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