Joint injections are used for a variety of issues, most commonly conditions such as osteoarthritis or inflammation of tendons and ligaments (biceps tenosynovitis and others). Different products can be injected with different aims. Joint injections are often used as part of long-term management of osteoarthritis in joints with conditions thatn cannot be cured such as elbow dysplasia.
Products:
Corticosteroid: These rapidly reduce inflammation within the joint or the tissue injected. They can be used as a treatment or as a diagnostic to demonstrate inflammation in a particular joint is the cause of lameness. Depending on the condition, benefits may be short lived. Long term use of steroids inside joints may not be recommended due to concern for cartilage damage.
Hyaluronic acid: This is a normal substance found in joints that aid with lubrication and minimize friction. Joint fluid in diseased joints is often too thin and filled with inflammatory cells. Hyaluronic acid is injected to restore viscosity and to help decrease inflammation.
Platelet-rich plasma (PRP): This is a product that is created using the patient’s own blood. The whole blood is sent through a special filtration device to concentrate platelets resulting in increased levels of growth factors and anti-inflammatories. These components play a role in the natural healing of injuries and help to jump start the healing process. The APS product available at VOC is Prostride developed by Zoetis.
Autologous Protein Solution (APS): This is a product that is created using the patient’s own blood. The whole blood is sent through special filtration devices which produces a concentrated protein and cell solution rich in anti-inflammatory cytokines and growth factors. The goal is to help with pain and accelerate the patient’s own healing process. Results are usually seen in 2-4 weeks following injection and may last 9-12 months depending on response and may be repeated. The APS product available at VOC is Prostride developed by Zoetis.
Process:
A consult is required prior to considering joint injections to ensure that is the best recommendation for the patient. Diagnostics may be recommended to rule out anti-immune or infectious conditions where joint injections are contraindicated. The consult should be treated as an opportunity to discuss all diagnostic and treatment options regarding a patient’s condition as joint injections may not be the best starting treatment in many cases. Joint injections are usually not performed at the initial appointment and must be scheduled for a procedure day. Joint injections are often used as part of long term management of osteoarthritis from conditions such as elbow dysplasia rather than a front-line treatment.
Treatment:
Joint injections are often performed under heavy sedation or anesthesia to ensure that the product is placed in the correct tissue/space. Bloodwork and further work-up may be required to ensure that patient is healthy enough for sedation/anesthesia. The patient would be dropped off in the morning and picked up later in the day.
Recovery:
Activity restriction for 4-6 weeks following joint injection is often recommended to allow inflammation to decrease. This is followed by a slow return to normal activity.
Follow-up:
Depending on the product used and goals of treatment, additional injections in the future may be an option if pain or lameness returns.
Expectations:
These products are often used to manage long term conditions such as arthritis from elbow dysplasia and are not a cure. In cases of osteoarthritis, some amount of lameness is expected and management (follow up joint injections, weight management, encouraging low impact activity, additional medications such as oral pain medications) will be needed long term.