I’ve had a total of seven HA (hyaluronan or hyaluronate) injections in my right knee to help alleviate the effects of the cartilage damage behind my patella and on my lateral tibial plateau. The first was a single Synvisc injection in October 2011. That was followed by a series of three Euflexxa injections in the summer of 2012. The last series was another three Euflexxa injections in June 2013. The series of three injections were administered with a week between each one.
I previously wrote a bit about the injections when I was explaining the road that led me to the DeNovo NT cartilage transplant in September 2012. The injections were initially derived from rooster combs. I find it both odd and fascinating that scientists can develop medical treatments from just about anything.
These HA injections never really helped me; I couldn’t tell a difference at all after getting the injections. They didn’t hurt anything (except for the pain immediately after the injection that lasted only a short while), but they didn’t help. Now, I feel vindicated in my assessment that they were a waste of time and money.
Last June, the AAOS (American Academy of Orthopaedic Surgeons) released an updated clinical practice guideline (CPG) that says, “We cannot recommend using hyaluronic acid (HA) for patients with symptomatic OA of the knee.” Apparently, despite a publication bias toward positive results (meaning that “studies with results that did not support viscosupplementation were less likely to be published than studies with positive results”), the current literature still doesn’t support a recommendation to use HA injections in clinical practice. Very interesting. Unfortunately, this CPG was released at the same time I was getting the last injection, so I didn’t know at the time that literature doesn’t show a “clinically effective response.”
Again, I don’t think the injections I received hurt anything, but I’m glad to know that these things are being monitored and new recommendations are being made, despite potential implications to clinical practice.
Physical Therapy Update
Not much to talk about with physical therapy this week. We added the leg press in again last week, and that’s proved a bit challenging because I sometimes get a shooting pain through the lateral side of my knee. It happens right before I get to full extension. This has also happened twice after I’ve finished in the pool and once, randomly, last Sunday when I was walking through my living room. Not sure what’s up, but I’m being as careful as possible to avoid that ridiculousness while not scaling back too much.
PT suggested that it’s time we spaced our appointments out a little further, stretching them from once a week to once every two weeks. I’m good with this because I’m making such slow progress, we’re not even adding new exercises every week, so this gives me more time to progress between formal sessions. I’ll just need to simultaneously keep myself in line doing only the things I’m “allowed” to do and keep myself motivated to continue the PT exercises despite being bored doing the same things for weeks on end. If you’ve read more than one post on this blog, you’ll know that’s going to be a challenge for me. A big challenge.
Last weekend was the sunniest and warmest that we’ve had yet this year. So that obviously meant I needed to ride my bike. I swear there must be a medical condition in which sunshine makes me do irrational things. Because thirty-six miles later, I finally called it quits for the weekend. That’s approximately 28.9 miles over my PT-imposed weekly limit of 7.5 miles. Whoops! I’m monitoring my recovery this week before I really determine if it was worth it. At the moment, I’m glad that I still have another week and a half to recover before I see PT again. True story.