Managing Knee Swelling After Joint Fluid Injections: Key Questions Answered

Swelling of the knee joint after injection of joint fluid?

Dear Dr.
Chen,
My mother is currently 62 years old, 155 cm tall, and weighs 80 kg.
Due to her age and weight, her knee joints have deteriorated, causing pain while walking.
She underwent arthroscopic surgery on July 21, 2002 (both knees were operated on) and debris was removed from both joints.
However, only the left knee received hyaluronic acid injections on August 21, followed by additional injections on August 28, September 4, September 11, September 18, March 19, September 29, October 6, October 13, October 20, and October 27, totaling 11 injections.
Unfortunately, the pain has not improved, and her knee is swollen.
She is scheduled for another injection this April.

I would like to ask Dr.
Chen the following questions:
1.
How many hyaluronic acid injections are typically needed to achieve a better therapeutic effect? Are there any side effects?
2.
What should be done about the swelling in her left knee, and what could be causing it?
3.
Before the arthroscopy, her left knee was not painful; only the right knee was causing issues.
After the surgery, the right knee pain resolved, but now she is experiencing pain in the left knee.
Why is this the case? (The doctor mentioned that both knees were aging, which is why both were operated on.)
4.
A friend of mine also received hyaluronic acid injections without prior joint debris removal, and he experienced good results with no pain while walking.
Could this be related to not having the joint cleaned?
5.
If she were to undergo a knee replacement, what are the potential side effects? What should she be cautious about in daily life? How long can a prosthetic joint last?
6.
She is currently taking glucosamine supplements.
Are there any side effects associated with this?
P.S.
I apologize for the numerous questions and appreciate your understanding.
I would be very grateful for your response.
Thank you!

Ms. Chen, 30~39 year old female. Ask Date: 2004/01/26

Dr. Chen Xingyuan reply Orthopedics

Dear Ms.
Chen,
Based on your description, your mother is likely experiencing knee pain due to osteoarthritis.
Osteoarthritis is a natural phenomenon in the human body, similar to how machines or tires wear out over time.
The rate of degeneration or wear varies from person to person, influenced by factors such as age, physical constitution, activity level, and genetics.
Knee osteoarthritis is classified as a chronic condition that cannot be completely cured; the goal is to maintain or control it in a good state and prevent further deterioration.
It is akin to an old car; if used recklessly, it will soon break down.
However, with proper care and maintenance, it can still serve well for a long time.
The treatment for knee osteoarthritis should be approached from three levels: protection and maintenance, medication, and surgical intervention.
The most important step is to reduce the burden on the knee joint.
Activities that should be minimized include squatting or kneeling, climbing hills or stairs, carrying heavy objects, and standing or walking for extended periods, as these can increase wear on the knee joint.
If exercise is necessary, walking on flat ground or gentle slopes for 20 to 30 minutes is advisable, and using a cane or knee brace may be beneficial.
Swimming is also a good option as it provides exercise with less strain on the knee.
For daily care, applying heat with a heating pad or warm water can help maintain the joint in good condition.
Engaging in moderate rehabilitation exercises is crucial to prevent thigh muscle atrophy and knee stiffness.

In terms of medication, options include non-steroidal anti-inflammatory drugs (NSAIDs), glucosamine, and intra-articular injections of hyaluronic acid.
When the knee joint wears down, debris can accumulate within the joint, leading to inflammation, swelling, and pain.
In such cases, NSAIDs can be an effective treatment.
Although these medications are effective for pain and inflammation, they may cause gastrointestinal discomfort or increase the burden on the liver and kidneys.
It is generally recommended to avoid medication unless the pain is significant, with the aim of maintaining normal knee function with minimal drug use.
Glucosamine can aid in the repair of knee cartilage, while hyaluronic acid acts as a high-quality lubricant, protecting the cartilage surface and reducing joint wear.
Intra-articular injections of glucosamine and hyaluronic acid typically have few serious side effects, but their effectiveness in treating severe knee osteoarthritis is limited.
Currently, it is recommended to administer hyaluronic acid injections once a week for five consecutive weeks to alleviate knee pain and reduce the need for NSAIDs.
Surgical options include arthroscopic surgery and total joint replacement.
Arthroscopic surgery primarily aims to remove inflammatory debris from the knee joint, often yielding good short-term results, though the duration of effectiveness can vary widely among individuals.
When conservative medical treatment is ineffective and X-rays show severe joint wear, total joint replacement surgery may be necessary to resolve the issue.
Modern joint replacements are designed to function well for over ten years.
The goal of surgery is to alleviate pain and correct deformities to facilitate smooth walking; however, complications such as wound infections, loosening of the artificial joint, or wear can occur, though these are rare.
More than 95% of patients report satisfactory outcomes post-surgery.
In summary, while medication is a part of the treatment for knee osteoarthritis, the protection and maintenance of the knee joint are of utmost importance, and total joint replacement surgery should be considered only as a last resort.
Wishing you peace and well-being!
Sincerely,
Dr.
Chen

Reply Date: 2004/01/26

More Info

Managing knee swelling after joint fluid injections can be a complex issue, especially for individuals with a history of knee problems. Based on the information provided, here are detailed answers to your questions regarding your mother's knee condition and treatment options.

1. How many joint fluid injections are needed for effective treatment? Are there side effects?
The number of joint fluid injections required can vary significantly from person to person. Typically, patients may receive one to three injections over a period of weeks, depending on the severity of their symptoms and the specific type of joint fluid used. Hyaluronic acid injections, for example, are often administered in a series of three to five injections. While these injections can provide relief, they may also have side effects, including temporary swelling, pain at the injection site, and in rare cases, allergic reactions. It's essential to monitor for any adverse effects and discuss them with the treating physician.

2. What should be done about the swelling in the left knee? Why is it swollen?
Swelling in the knee can occur for several reasons, including inflammation, fluid accumulation, or a reaction to the injections. To manage the swelling, your mother can apply ice to the affected area, elevate her leg, and rest as much as possible. Compression wraps may also help reduce swelling. If the swelling persists or worsens, it is crucial to consult her physician, as this could indicate an underlying issue that needs to be addressed.

3. Why did the left knee become painful after the arthroscopy, even though it was not painful before?
It's not uncommon for patients to experience pain in a different knee after undergoing arthroscopic surgery on the other knee. This phenomenon can occur due to compensatory mechanisms; when one knee is treated, the other may bear more weight or strain, leading to discomfort. Additionally, both knees may have underlying degenerative changes that were not symptomatic before the surgery. This highlights the importance of comprehensive evaluation and management of both knees, especially in older patients with osteoarthritis.

4. Could the effectiveness of joint fluid injections be related to whether or not the joint was cleaned beforehand?
Yes, the effectiveness of joint fluid injections can be influenced by whether the joint was previously cleaned of debris. Arthroscopic debridement can help remove loose bodies, damaged cartilage, and other irritants, potentially improving the joint's environment for the injections to work effectively. If the joint is filled with debris, the injections may not provide the desired relief, as the underlying issues may still be present.

5. What are the potential side effects of knee replacement surgery? What should be considered in daily life? How long can artificial joints last?
Knee replacement surgery can have several side effects, including infection, blood clots, and complications related to anesthesia. Post-surgery, patients may experience pain, stiffness, and swelling as part of the recovery process. It's essential to follow rehabilitation protocols to regain strength and mobility. In daily life, patients should be cautious about high-impact activities that could stress the artificial joint. Generally, artificial joints can last 15 to 20 years, but this can vary based on factors like activity level, weight, and overall health.

6. Are there any side effects from taking glucosamine supplements?
Glucosamine is generally considered safe for most people, but it can cause mild side effects such as gastrointestinal discomfort, nausea, and diarrhea. It may also interact with blood-thinning medications, so it's crucial for your mother to discuss her supplement use with her healthcare provider, especially if she is taking other medications.

In summary, managing knee swelling and pain after joint fluid injections requires a multifaceted approach, including monitoring for side effects, managing swelling with rest and ice, and considering the overall condition of both knees. If symptoms persist or worsen, further evaluation and treatment options, including potential surgical interventions, should be discussed with her healthcare provider. Regular follow-ups and open communication with her medical team will be essential for optimal management of her knee health.

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