OrthoArizona – Arcadia Options for Injections of Painful Joints, Tendons or Bursa

Painful joints due to causes of arthritis, tendinitis, cartilage injury, and overuse are generally treated with conservative treatment modalities such as rest, ice, physical therapy, non-steroidal anti-inflammatories.  Another option is have the joint/tendon injected.

Please note that these are simplified presentations these different injectable materials.   My intent is to provide a simple explanation of treatment options that will be available to you when you are seen in our office.

Materials available for injection by Dr. Wilmink are:

  1. Short acting Steroids/Coritsone- Depo-medrol, Kenalog, and Betamethasone
    1. These are safe medications for use in the joint as long as they are not done too frequently as they may lead to cartilage damage.
    2. Steroids will reduce inflammation and therefore reduce pain.
    3. Benefit from the injection can last anywhere from several weeks to many months.
    4. These injections are typically covered by your insurance depending on co-pay and deductible parameters of your insurance.
    5. If you have a steroid injection into an arthritic joint, we recommend that you do not have a joint replacement on that joint for at least three months after the injection. Joint replacement surgery within three months of a steroid injection has been associated with a higher rate of post-operative infection.
    6. An injection typically takes about 3 seconds and is not usually associated with an extreme amount of pain. Please watch this video of an injection being given in our clinic   >>>
  1. Long acting Steroid- Zilretta
    1. Recently approved by the FDA as a long acting steroid for the treatment of knee arthritis only.
    2. The drug is meant to stay in the knee for a longer period of time and deliver at least 3 months of treatment/benefit.
    3. This is currently approved as a one-time injection.
    4. Cost of the drug is approximately $515.00 and insurance benefits are unknown at this time. You may have to pay for this out of pocket and then get reimbursed by your insurance company.  This process is called “buy and bill”.
    5. This is a new treatment that just became available at the end of 2017 and we are still working on the logistics of providing this for patients.
    6. For further clinical information please refer to zilretta.com
  1. PRP- Platelet Rich Plasma
    1. This involves collecting your blood and then having it spun in a centrifuge to separate out the platelet rich plasma. This concentrate of biologically active elements of your blood has anti-inflammatory and healing affects.   The total time for blood collection/centrifuge/injection is approximately 30 minutes.
    2. This can be injected into painful joints, painful tendons and bursa areas.
    3. This injection is not covered by insurance carriers, please call us at 602.631.3165 for pricing.
  1. Hyaluronic Acids are used only for arthritic joints- Synvisc, Orthovisc, Supartz, Gel-One, etc. Sometimes these injections are called “Rooster Comb Injections, Gel Shots, ”
    1. These injections are approved for treatment of arthritis in the knee only.
    2. These injections can be done in a single visit, or some of them are done a week apart for a series of three or five. We typically recommend a single injection.
    3. You can walk and drive after the injection is given
    4. These injections can provide relief from pain and swelling for up to 6-12 months. We cannot predict how long it will last for each patient.
    5. In order to be approved for this medication, it requires documentation demonstrating that there has been no improvement with previous treatments of anti-inflammatories, physical therapy, walking aids, steroid injections, and rest.
    6. Once the medication is ordered, it will take approximately 3-4 weeks for your insurance to approve it and ship it to our office. You will be notified by our office when we have the medication and an appointment will be made to come in for your injection.
    7. Cost of the injection will depend on your insurance and your deductible amounts.
    8. The injection can be done every 6 months if effective
  1. Stem Cell injections/Amniotic Fluid injections
    1. Amniotic fluid contains concentrations of hyaluronic acid, growth factors, and stem cells.
    2. This injection is not covered by insurance, please call us at 602.631.3165 for pricing.
    3. This is an FDA approved treatment.
    4. We do not offer this treatment for patients with “bone on bone” arthritic changes.
    5. Typically this injection is offered to patients who have failed to have improvement with steroid or hyaluronic injections, or for patients who want to pursue a biologic regenerative medical treatment option.
  1. Pure Stem Cells Injections
    1. This treatment is currently only offered by our practice for patients with the disease process known as avascular necrosis/osteonecrosis of the hip. This is a procedure that is performed in the operating room.
    2. Stem cell injection into a joint in the office is an experimental procedure and our clinicians are waiting for clinical studies, currently under way, to be published before we consider offering this procedure to our patients.