WHEN SHOULD WE INJECT A PET”S JOINT?
1) In conjunction with rehabilitation therapy as part of a conservative pain management plan
2) Patients who have residual post-operative symptoms including effusion, discomfort or lameness and have not responded to medical management or rehabilitation therapy
3) Patients whose bodies are intolerant of or non-responsive to non-steroidal anti-inflammatory medications (NSAIDs)
4) As a supplement or alternative to oral medications
5) Patients who have inflammatory joint disease
6) Patients with progressively worse osteoarthritis
7) To aid joint blocking for dogs who are lame but do not yet have a definitive diagnosis
At Mission Animal Hospital, we rely on four intra-articular products: Hyaluronic acid, corticosteroids, stem cell therapy, and platelet-rich plasma.
HYALURONIC ACID: Hyaluronic acid is a naturally occurring fluid inside all living organisms. As a joint protective agent, HA is beneficial in lubricating joints, decreasing inflammation and degradation, and repairing cartilage. Intra-articular HA has been widely used to treat osteoarthritis in both large animals and humans. Several experimental studies have demonstrated its effectiveness in treating dogs with osteoarthritis. HA products include Hyalovet®, Hylartin®, Legend® and Synvisc®. In studies, Hylartin®V has proven to be the most similar to the hyaluronic acid naturally occurring in the body, which is why we prefer it to other products on the market.
Recent HA study results at an eastern rehab practice showed…
a) the average dog saw improvement for up to 6 months postoperatively.
b) 70% of injected dogs responded well; 20% were judged mildly improved; 10% did not respond
For dogs who do not respond to intra-articular HA injections, corticosteroids are recommended (Depo-Medrol® or Triamcinolone).
CORTICOSTEROIDS: Patients who do not respond to intra-articular hyaluronic acid may benefit from corticosteroids, such as Depo-Medrol® or Vetalog®. Within 12 to 24 hours after corticosteroid injections, patients have demonstrated pain relief lasting weeks or months. In cases where corticosteroids fail to provide pain relief, it is often due to failure to correctly target the synovial space before injecting.
CHOOSING BETWEEN HYALURONIC ACID AND CORTICOSTEROIDS FOR ARTHRITIC PATIENTS:
A) For mild arthritis and synovitis– HA once weekly for 3 weeks
B) Moderate arthritis, or non-responsive to HA– Triamcinalone once, then another injection 2 weeks later if needed.
C) Severe arthritis– Depo Medrol once, followed by another injection three weeks later if needed.
STEM CELL THERAPY: Can offer great benefit to the patient with chronic arthritis or joint cartilage damage.
Clinical response seen to stem cell therapy in arthritic dogs:
-Significant improvement in lameness
-Increased range of motion
-Significant improvement in comfort, as judged by pet owners
PLATELET-RICH PLASMA: Platelet-rich plasma is blood plasma with concentrated platelets that contain reservoirs of bioactive proteins and growth factors. These bioactive proteins initiate and accelerate tendon and ligament repair and regeneration. Professional athletes that have improved with PRP include Kobe Bryant, Hines Ward and Troy Polamalu. PRP is typically used for tendon and ligament injuries, while stem cell therapy is indicated for chronic inflammation or cartilage damage.
THE MOST IMPORTANT FACT? At Mission Animal Hospital, we’ll help you and your painful pet however we can. We promise.