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 a new promising treatment option used to manage knee arthritis. The article discusses this new injection 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:

Steroids injections

Hyaluronic acid injections

Platelets-rich plasma (PRP) injections

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

What are the new treatments for knee arthritis?

Arthrosamid is a promising new treatment option for knee arthritis that originated in Denmark and has been available in the UK for a few 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 also been used to treat knee osteoarthritis in humans effectively.

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. Arthrosamid Hydrogel injection can help reduce this inflammation as it will be taken up by the synovial cells, which become more spaced out, reducing the transmission of inflammatory signals. The hydrogel also acts as a cushion within the knee joint. It takes about 6-8 weeks after the injection for Arthrosamid to integrate with the synovial cells and start reducing knee joint pain and swelling.

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 swelling 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]. The latest data on Arthrosamid injection indicates its effectiveness is sustained in many patients even 3 years after the procedure. This prospective study included patients with an average age of approximately 70 years. The research found that the hydrogel forms a stable, long-lasting layer covering the joint surface [2]. Before these studies, there were also assessments conducted on the effect of Arthrosamid when injected into arthritic animal joints, primarily horses. In a multi-centre study spanning a two-year period, Arthrosamid injections demonstrated a significant improvement in joint function and a reduction of joint effusion [3].

Is Arthrosamid suitable for me?

Arthrosamid is approved for treating symptomatic knee osteoarthritis and is a suitable treatment option for most patients. You should always consult a specialist to provide more information about this.

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 done?

You will need a single dose of antibiotic before the procedure to reduce the risk of infection. An ultrasound scan of the knee will be performed before the injection to determine the best site for the procedure and assess any excess fluid within the knee joint. Then, the skin will be cleaned and prepared using a sterile technique. A small amount of local anaesthetic (numbing medicine) will be used before the procedure. Then, under continuous ultrasound guidance, Arthrosamid hydrogel will be injected accurately into the knee joint. If there is excess fluid within the knee joint, this will be aspirated (taken out) before the Arthrosamid injection.

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.

After the injection, we recommend avoiding strenuous activities and resting the knee for approx. 1 week to minimise the risk of inflammation or flare-up following your procedure.

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

What are Arthrosamid injection side effects?

Studies have demonstrated that Arthrosamid injections 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 and lasts for up to four weeks, including feelings of joint pain and swelling. If you have a Baker's cyst, it may feel distended.

-Allergic reaction. This is rare.

-Infection. This is very rare since the procedure uses a strict sterile technique, and a single-dose antibiotic is given before the procedure.

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 longer-lasting cushioning and lubrication. Additionally, Arthosamid is a single-dose injection that usually provides a prolonged effect, unlike other treatments like steroids, PRP and low molecular weight Hyaluronic acid, which usually require multiple or repeated injections.

Arthrosamid vs Hyaluronic acid

Hyaluronic Acid is a natural substance found in tendons and ligaments, and the body can degrade it; Arthrosamid Hydrogel, on the other hand, is non-degradable, lasting much longer within joints.

What are the contraindications to Arthrosamid injections?

Arthrosamid may be contraindicated if:

If there is an infection within the knee or the overlying skin.
If the knee has a replacement or prosthesis.
Previous knee keyhole surgery (arthroscopy) within 6 months
If you have certain conditions that can affect the joints, like haemophilia, autoimmune disease, or inflammatory arthritis.
If you had a recent hyaluronic acid injection into the knee, you must wait until it is absorbed (the duration varies according to the hyaluronic acid preparation).

What is Arthrosamid UK injection cost?

Please contact our clinic for information about the cost and arrangements of 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, although there are no reported cases of infection secondary to Arthrosamid injections.

How long will Arthrosamid effect last?

Recent studies indicate that Arthrosamid benefit was maintained at 3 years of follow-up. The manufacturer of Arthrosamid (Contura) is continuously assessing the long-term response to the hydrogel treatment. The Arthrosamid hydrogel cannot be degraded by the body, providing long-term 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)?

Although Arthrosamid can help reduce inflammation in patients with inflammatory-type arthritis (for example, rheumatoid and psoriatic arthritis), it has not been approved for this specific 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?

You should avoid vigorous weight-bearing activities like running and long walks for the first few days following the procedure. We advise avoiding strenuous activities for about a week after the injection.