Knee Injections

Corticosteroids

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Corticosteroids (also called cortisone) are very powerful anti-inflammatories, and so can be very useful for treating conditions where there is inflammation. The steroid is normally mixed with local anaesthetic and is given as a single injection. The local anaesthetic works very quickly and gives rapid pain relief but also wears off quickly, after several hours. Corticosteroids, however, can take 24 or even 48 hours to kick in and start working. For the first couple of days after a steroid injection the area may be uncomfortable, with a burning feeling, but this nearly always then disappears.

People are sometimes concerned about the possible side effects of a corticosteroid injection, associating it with the concept of being ‘on steroids’. The significant potential side effects that are sometimes associated with steroid, such as water retention, thinning of the bones, problems with hormones and so on actually relate to patients being given very high doses of steroids or being put on long courses of steroid tablets, and this does NOT apply to being given a local steroid/cortisone injection.

Patients with arthritis of the knee can be treated with corticosteroid injections. The response from this is however variable and can range from a few weeks to a few months. Some patients if appropriate can undergo more than one injection a year.

Hyaluronic acid

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Hylans are molecules that are found within the normal fluid within a joint. They are very long chain molecules, so when provided in a liquid form they are very viscous. There are some people who think that by injecting hyaluronic acid into a knee you are ‘lubricating’ the joint – like changing the oil. There are others who believe that injecting hylans into a joint has a chemical/drug effect. Whatever the actual underlying processes might be, it has been shown that injecting hyaluronic acid into an arthritic joint gives significant symptomatic improvement in over 75% of patients, with decreased pain and increased mobility. Some patients feel symptom improvement straight away after an injection, but in many it can take a few weeks before the full benefit is felt. The degree and length of symptom improvement does vary considerably between patients, but some people gain significant benefit for up to 12 months after an injection.

Some insurance companies will fund hyaluronic acid injections but others won’t.

nSTRIDE^® Autologus Protein Solution

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Knee pain is a common symptom experienced by people of all ages. It can be caused by a traumatic event, or by normal wear and tear that can become worse over time, likely due to arthritis. Osteoarthritis is the most common type of arthritis and happens when cartilage, the rubbery padding that protects the ends of bones, wears out in your knee over time. It can affect people differently, with some just feeling minor discomfort while others have trouble doing day-to-day tasks. As well as joint pain and stiffness, osteoarthritis can cause swelling, tenderness and a gritty, rasping feeling in your knee.

The nSTRIDE APS injection treatment is designed to alleviate pain and bring balance back to your inflamed knee joint by introducing high levels of “good” proteins concentrated from your own blood. These good proteins can block the “bad” proteins responsible for the inflammatory condition in your joint. At the same time, nSTRIDE APS also concentrates growth factors which are beneficial for cartilage health.

What’s involved in nSTRIDE APS?

The treatment is designed to be a single injection therapy in the out-patient clinic setting. Blood is withdrawn like a simple blood test, the clinician processes the patient’s blood to concentrate white blood cells, platelets, and plasma proteins into a small volume of plasma. It is autologous, not a synthetic therapy and does not require cell culture.

The prepared nSTRIDE APS (approx 2-3 ccs) is administered as a joint injection directly into the knee joint cavity, the injection offers:

• Anti-inflammatory effects
• Joint pain reduction
• Promotion of cartilage health
• Improvement of joint function

You may experience side effects (e.g. bruising, local pain or swelling) associated with the blood draw or knee injection. It’s important to remember that there is no cure for osteoarthritis but successful treatment with nSTRIDE APS may reduce or relieve your pain which may increase your mobility and comfort. Your osteoarthritis may not improve or may get worse.

The Science Behind nSTRIDE APS

In an osteoarthritic knee, inflammatory cytokines (“bad” proteins) outnumber anti-inflammatory cytokines (“good” proteins) causing an imbalance resulting in knee pain and cartilage degeneration. The “bad” proteins attack the cartilage and must be stopped simultaneously to decrease pain and slow cartilage degeneration.

The prepared nSTRIDE APS introduces high levels of “good” proteins that is designed to overwhelm and block the “bad” proteins. These “good” proteins may help stimulate a biologic cascade which has been shown to block cartilage destruction in osteoarthritis. The pain in the joint may be reduced, and the joint function may be improved. The ongoing destruction of cartilage may also be slowed.

Laboratory, animal and human studies have shown that nSTRIDE APS has decreased pain and slowed cartilage degeneration, unlike traditional therapies.

• Significantly Reduces Pain Associated with Knee OA up to 3 years
• Significantly improves Mobility in the Knee Joint associated with OA
• 70% Improvement in Knee Pain at 3 years following a Single Injection

Frequently asked questions

When will the treatment start to work?
Pain relief may be expected after one to two weeks.

Is nSTRIDE APS safe?
Yes. Studies have demonstrated the safety of nSTRIDE APS

Will I be able to be active as usual during the course of my treatment?
It is recommended that you minimize your activity level for 14 days (but not to exceed pre-injection levels).

How long can I expect the benefits to last?
Based on preclinical and early clinical results, patients may expect to see benefits for up to 36 months.

Who can be treated with the nSTRIDE APS?
Patients with mild to severer knee osteoarthritis can receive nSTRIDE APS therapy.

How many injections of nSTRIDE APS are required?
Clinical studies have demonstrated the effectiveness of one injection. Studies suggest one injection can last up to 36 months.

Clinical evidence references

• Kon E, Engebretsen L, Verdonk P, Nehrer S and Filardo G. “Autologous Protein Solution Injections for the Treatment of Knee Osteoarthritis. 3-Year Results.” The American Journal of Sports Medicine 2020;48(11):2703–2710.
• A Multicentre, Double-Blind, Randomized, Placebo (Saline) - Controlled Pilot Study of a Single , Intra-Articular Injection of Autologous Protein Solution in Patients with Osteoarthritis of the Knee. Clinical Investigation Report – 36 Month, APSS- 33- 00, Version 1.0 14 January 2019.

Comparison table