Arthrosamid Injection for Knee Arthritis

Arthrosamid injection; a new treatment for knee arthritis!

Knee osteoarthritis is one of the most common conditions in our clinical practice. Treatment usually starts with conservative measures and anti-inflammatory medications. Injection therapy plays an important role in the management when conservative treatment is not working. Arthrosamid is long-lasting, non-degradable hydrogel treatment used to manage knee arthritis. The article discusses this new treatment for knee arthritis and answers the frequently asked questions.

What is osteoarthritis?

Osteoarthritis is a degenerative joint condition that results in gradual wear of the articular cartilage (the protective tissue that covers the bone surfaces at joints). The cartilage acts as a shock absorbent and ensures smooth and frictionless movement. When there is cartilage wear, the bones will rub against each other, resulting in pain, swelling and stiffness. Knee osteoarthritis is particularly common, affecting around 20% of people over 45 in England.

Treatment usually consists of conservative measures, including leading a healthy lifestyle with diet, exercise, and weight loss and using painkillers and anti-inflammatory medications. Injection therapy plays an important role in the management when conservative treatment is not working. The usual injection options for managing knee osteoarthritis include steroids, Hyaluronic acid and PRP injections. The other management end would involve surgical treatment and getting a joint replacement.

What is the treatment for knee osteoarthritis?

Treatment usually starts with conservative measures, including leading a healthy lifestyle with diet, exercise, and weight loss. It also includes using anti-inflammatory medications like Ibuprofen to control the symptoms. Exercise and weight reduction are the two most effective approaches for treating knee osteoarthritis.

The most common injection treatment options for managing knee osteoarthritis include:

Surgical management includes getting a joint replacement (partial or complete joint replacement).

What are the new treatments for knee arthritis?

Arthrosamid is a promising non-surgical treatment for knee arthritis that originated in Denmark and has been available in the UK for several years.

What is Arthrosamid?

Arthrosamid is a non-biodegradable hydrogel material that can be injected into the knee joint to provide cushioning and reduce joint pain and stiffness. It is composed of 2.5% polyacrylamide and 97.5% water. The polyacrylamide component makes it non-biodegradable, so it cannot be broken down by the human body.

Is Arthrosamid new in the UK?

This Hydrogel has been used for years to augment soft tissues and treat conditions like stress incontinence. It has been used for almost 14 years to treat horses with arthritis. In recent years, Arthrosamid has shown considerable promise as a new treatment for knee osteoarthritis in humans.

How does Arthrosamid work?

The knee joint is lined by a special thin membrane (the synovium) comprising small synovial cells. These are responsible for producing the special lubricant fluid within our joints. When there is arthritis, the synovium is often inflamed and irritated, known as synovitis. Following injection into the knee joint, Arthrosamid integrates into the synovial tissue of the inner joint capsule. It forms a cushion-like membrane, with the hydrogel incorporated into a fine tissue network covered by the synovial lining. This is thought to reduce joint stiffness and pain and improve knee function.
Arthrosamid is non-absorbable and non-degradable and therefore remains within the synovial tissue rather than being broken down by the body..

What is the evidence for using Arthrosamid injections in knee arthritis?

Over the past few years, various small studies have assessed the effectiveness and safety of Arthrosamid in treating knee arthritis. These studies have indicated significant improvement in knee pain and function following the injection, as well as enhancement in the scores used to evaluate the severity of knee arthritis and its impact on the quality of life. Recently, there have been larger and more robust studies assessing Arthrosamid effect. In a multi-centre, double-blinded, randomised controlled trial comparing the effects of Hydrogel injections versus Hyaluronic acid, good outcomes were observed in both patient groups for up to one year [1].

More recent studies have now followed patients for up to five years after a single Arthrosamid injection. In the five-year extension of the randomised trial, 119 patients originally received Arthrosamid, 91 entered the long-term extension and 58 completed five-year follow-up. At five years, average WOMAC pain scores remained improved by 16.2 points compared with before treatment, with sustained improvements also seen in stiffness, physical function and patients' overall assessment of their arthritis.
A separate prospective study has also reported sustained improvement up to five years after a single injection. Of 49 initially treated patients, 27 completed five-year follow-up, with significant improvements in pain, stiffness and physical function maintained at five years. These studies suggest that the benefit of a single Arthrosamid injection can persist for several years in some patients. However, individual responses vary and not every patient will obtain the same degree or duration of improvement. PubMed Central (PMC) [2].

Is Arthrosamid suitable for me?

Arthrosamid is approved for treating symptomatic knee osteoarthritis in adults who have not obtained sufficient improvement from conservative treatments.

It may be considered in patients who continue to experience knee pain despite treatments such as exercise, weight management, painkillers or previous injection treatments and who are looking for a longer-lasting non-surgical treatment option.
The severity of your arthritis, your symptoms, previous treatments and your medical history will be reviewed before deciding whether Arthrosamid is appropriate for you.
Degenerative meniscal tears and symptoms such as clicking do not necessarily prevent treatment if the main problem is osteoarthritis. However, Arthrosamid does not repair a meniscal tear, and significant mechanical symptoms such as true locking may require further assessment.

How to get Arthrosamid injection?

The Arthrosamid hydrogel is injected directly into the knee joint using ultrasound guidance. This is crucial to ensure maximum precision and accuracy in its delivery to the knee joint. Evidence shows that unguided knee injections accuracy is approx. 80%.

How is Arthrosamid injection for knee arthritis done?

Step 1

You will be given a single dose of prophylactic antibiotic to reduce the chances of infection.

Step 2

An ultrasound scan of the affected knee will be performed. This will locate excess fluid and help decide the best location for administering the injection.

Step 3

The knee will be thoroughly cleaned using a sterile method to prep it for the injection.

Step 4

A local anaesthetic will be administered to avoid pain during the procedure.

Step 5

If there is excess fluid, it will be aspirated.

Step 6

Ultrasound guided Arthrosamid injection will be administered into the affected area, ensuring precise medication delivery.

Step 7

After the procedure is completed, the injection site will be covered with a plaster to protect it from infection.

What happens after the procedure?

After your procedure, you will be monitored for 10-15 minutes to ensure no adverse reactions. After the local anaesthetic has worn off, you may experience mild joint discomfort, pain, or swelling. Please continue to use your usual painkillers.

Gentle everyday movement is encouraged following the injection. However, strenuous activities such as running, tennis and long walks should be avoided during the first few weeks following treatment. You can then gradually return to your usual activities as the knee settles.

Typically, the benefit from the injection begins around four weeks after the injection, with maximum benefit observed around the 12-week mark.

How long do the effects of the Arthrosamid® injection last?

Studies have now demonstrated sustained improvements in pain and function for up to five years following a single Arthrosamid injection in some patients. The duration and degree of benefit vary between individuals.

What are Arthrosamid injection side effects?

Studies have demonstrated that Arthrosamid injections for knee arthritis are generally well received by patients. Hydrogel injections have been used safely for various purposes for more than 20 years.

-The most frequently reported side effect is temporary discomfort at the injection site. This is usually mild to moderate and may include joint pain and swelling during the first weeks following treatment. If you have a Baker's cyst, it may feel distended.

-Allergic reaction. This is rare.

-Infection. This is rare since the procedure uses a strict sterile technique, and a single-dose antibiotic is given before the procedure. If you develop increasing pain associated with significant swelling, redness, heat around the knee, fever or feel generally unwell following the injection, you should seek medical advice promptly so that infection can be excluded.

What separates Arthrosamid from other injectable medications available today?

Arthrosamid is a unique injectable treatment that stands out from other options like steroid injections, platelet-rich plasma (PRP) and hyaluronic acid. Unlike those treatments, Arthrosamid is a non-degradable hydrogel that integrates with the synovial lining of the joint, providing a long-lasting effect within the synovial tissue. Additionally, Arthosamid is a single-dose injection that may provide prolonged improvement following a single treatment. Steroid, PRP and hyaluronic acid injections work differently and their benefits may be shorter-lasting or require repeat treatment.

There is currently insufficient evidence to say that Arthrosamid is superior to PRP for every patient. The most appropriate injection depends on factors including the patient's age, severity of arthritis, previous treatments and individual circumstances.

Will Arthrosamid injections for knee arthritis delay the need for a replacement surgery?

Arthrosamid® offers pain relief and improved joint function in patients who respond to treatment. Improving these symptoms may allow some patients to postpone knee replacement surgery. However, Arthrosamid does not reverse osteoarthritis or regrow damaged cartilage, and some patients may still eventually require knee replacement.

Having previously received Arthrosamid does not in itself prevent subsequent knee replacement surgery. Published follow-up has not identified unexpected abnormalities attributable to previous polyacrylamide hydrogel treatment in patients subsequently undergoing arthroplasty, although the available surgical data remain relatively limited.

Arthrosamid vs Hyaluronic acid

Hyaluronic Acid is a natural substance present within joint fluid and other connective tissues, and the body can degrade it; Arthrosamid Hydrogel, on the other hand, is non-degradable and remains permanently integrated within the synovial tissue.
A randomised controlled trial comparing Arthrosamid with hyaluronic acid found comparable improvements in the two groups during the first year. Longer-term follow-up has subsequently demonstrated sustained improvement in the Arthrosamid-treated group for up to five years, although the study was no longer a controlled comparison after the first year.Hyaluronic Acid is a natural substance present within joint fluid and other connective tissues, and the body can degrade it; Arthrosamid Hydrogel, on the other hand, is non-degradable and remains permanently integrated within the synovial tissue.
A randomised controlled trial comparing Arthrosamid with hyaluronic acid found comparable improvements in the two groups during the first year. Longer-term follow-up has subsequently demonstrated sustained improvement in the Arthrosamid-treated group for up to five years, although the study was no longer a controlled comparison after the first year.

What are the contraindications to Arthrosamid injections?

Arthrosamid should not be injected if:
- There is an active skin infection or skin disease at or near the injection site.
- The knee joint is infected or severely inflamed.
- You have previously received another non-absorbable injectable or implant in the same knee.
- You have recently received an absorbable injection such as hyaluronic acid which is not yet expected to have been absorbed.
- You have a knee replacement or other foreign material within the knee.
- You have undergone knee arthroscopy within the previous six months.
- You have uncontrolled haemophilia or are receiving uncontrolled anticoagulation treatment.
Additional caution is required in patients with an infection elsewhere in the body, autoimmune disease, immunosuppressive treatment, a compromised immune system, uncontrolled diabetes, or those undergoing major dental work or another invasive medical procedure. These are precautions rather than automatic contraindications.
Safety and effectiveness have not been established in patients under 18, pregnant or breastfeeding women, or patients with a BMI of 35 kg/m² or above.

What is Arthrosamid UK injection cost?

Please contact our clinic to know about Arthrosamid cost in the UK. We will be happy to answer any query about the procedure. Dr Al-Ani performs the procedure using ultrasound guidance to ensure safety and accuracy. He is a consultant Musculoskeletal Radiologist with extensive experience in image-guided intervention. Dr Al-Ani also trains others in musculoskeletal ultrasound and ultrasound injection techniques.

Can Arthrosamid be administered without ultrasound guidance?

We don't recommend this approach. Ultrasound improves the accuracy of injection into knee joints. Studies indicate that knee injections without ultrasound have only an 80% accuracy rate. It is important for Arthrosamid to be injected accurately into the knee joint for optimum results.

Patellofemoral joint ultrasound guided injection

Why do I need to take antibiotics before Arthrosamid injection?

A single dose of antibiotic treatment before Arthrosamid injection is needed because it is a permanent implant. The antibiotic will reduce the risk of infection. As with any injection into a joint, there is a small risk of infection, and prophylactic antibiotics are recommended with Arthrosamid treatment.

How long will Arthrosamid effect last?

Recent studies have now followed patients for up to five years following a single Arthrosamid injection. Improvements in pain, stiffness and physical function remained evident at five-year follow-up in many patients. Individual response varies, however, and this does not mean that every patient will experience five years of pain relief.

Can Arthrosamid treat other joints with arthritis (for example, the hip joint)?

While some medical professionals may administer Arthrosamid into joints such as the hip and shoulder, it has only been approved for use in the knee joint. As such, we do not recommend using it to treat arthritis in other joints.

Can Arthrosamid be used to treat inflammatory arthritis (like Rheumatoid arthritis)?

Arthrosamid is approved for the symptomatic treatment of knee osteoarthritis and is not approved specifically for treating inflammatory arthritis such as rheumatoid or psoriatic arthritis. Patients with autoimmune disorders require additional caution and individual assessment before treatment.

When will my knee pain start to improve?

Most patients start noticing pain relief within a few weeks after the injection, although it is possible to start feeling less pain within 24 hours. Typically, the benefit from the injection begins around 4 weeks after the injection, and it could take as much as 12 weeks to notice the full benefit from the procedure.

When can I restart my regular activities?

Gentle everyday activities can usually be continued following treatment. However, strenuous activities such as running, tennis and long walks should be avoided during the first few weeks after the injection. You can then gradually increase your activity as the knee settles. We recommend that you do not drive on the day of the procedure.

Should I tell my doctor/dentist about my Arthrosamid treatment?

You should tell your doctor or dentist that you have a permanent Arthrosamid implant if you have a surgical or dental procedure. They can then decide whether prophylactic antibiotics are required.

Are there any risks associated with Arthrosamid?

Arthrosamid injections for knee arthritis are generally considered safe. However, candidates should keep some general considerations in mind:

Postpone the treatment if you have infection in or around the knee
You will not be a candidate if you have haemophilia
Postpone the treatment if you have had knee arthroscopy within the last 6 months
The treatment is risky if you are having major dental work done
You might have to avoid the treatment while you are on anticoagulants
You might need to avoid treatment if you have an autoimmune condition
You should speak to your doctor and get tested for allergies to the components of Arthrosamid

Can I have Arthrosamid if I have a meniscal tear?

Degenerative meniscal tears are common in people with knee osteoarthritis and do not necessarily prevent you from having Arthrosamid. Arthrosamid is used to treat the symptoms associated with knee osteoarthritis; it does not repair the meniscal tear itself. If you have significant mechanical symptoms, particularly true locking where the knee becomes stuck, further assessment may be required before treatment.

What happens if Arthrosamid doesn't work or my pain eventually comes back?

Not every patient responds to Arthrosamid, and the degree and duration of improvement vary between individuals. If you have not obtained sufficient improvement after allowing adequate time for the injection to work, or your symptoms subsequently return, your knee should be reassessed by your GP, MSK specialist or orthopaedic team to discuss other treatment options.

Can I still have a knee replacement after Arthrosamid?

Yes. Having an Arthrosamid injection does not prevent you from having a knee replacement in the future if this becomes necessary. Available follow-up data have not identified unexpected abnormalities attributable to previous Arthrosamid treatment in patients subsequently undergoing knee replacement, although the published surgical experience remains relatively limited.

Can I have Arthrosamid if I have recently had another knee injection?

Tell us if you have recently had a steroid, hyaluronic acid or PRP injection before booking Arthrosamid. Hyaluronic acid should have been absorbed before Arthrosamid is administered. Steroids, PRP or other substances should not be injected at the same time as Arthrosamid, and recent injections will be considered individually before treatment