What is infiltration therapy?

An infiltration is the injection of a substance or medication into a specific area. Normally, the ones we hear about most are inside joints — the knee, the hip, the spine — but in reality, it can be done in all parts of the body for certain purposes.

Infiltrations with corticosteroids:

One of them is the steroid anti-inflammatory, which is the tried and true option. It is an anti-inflammatory that basically all types of infiltrations in tests and studies must be compared against in terms of effect and duration, or be comparable enough to be considered somewhat valid to start using it.

It is the cheapest and its effect is a little faster than others. It is injected with anesthetic and we usually wait about two weeks to see the full effect. What goes away, goes away; what remains, remains — and from there we see how long it will last. For many patients, it lasts a long time and works very well. Obviously, we combine this with other treatments to improve the effect, for example: physical therapy, medications, etc. For some patients, it doesn’t work as well. That sometimes tells us about the severity or how advanced the problem is, and unfortunately, if it doesn’t work well or doesn’t last long, it means that perhaps other options need to be considered.

Infiltration with PRP:

Platelet-rich plasma, simply put, involves drawing blood from the patient, processing or centrifuging it, and extracting the part that contains the platelets, which are then reintroduced.

The idea of reinjecting it, as I tell patients, is that it is the closest thing to something natural the patient can have to reduce inflammation and pain. It does not regenerate, it’s not magic, it will not create new cartilage or many of the things that are sometimes used to sell the idea of injecting it. It works very well when done properly, significantly reducing inflammation and pain, and it has some properties that might help in repairing certain tissues, but it will not regenerate.

It has been observed that platelet-rich plasma tends to last a little longer than steroid anti-inflammatory injections. The only downside is that it is recommended to be infiltrated 2 to 3 times.

The timing between each infiltration varies, but the idea is that if you decide to do it, it should be done properly. The cost is also a bit higher than steroids.

Infiltration with Hyaluronic Acid:

Hyaluronic acid is a substance that the knee or cartilage produces by itself. It helps somewhat with lubrication and nutrition of the cartilage, the impact of forces, and how all the cells in the knee’s biomechanics are managed.

It is a substance injected as a gel-like material that basically replaces the hyaluronic acid no longer present in the knee. It helps somewhat with lubrication, volume, and provides some nutrition to the cartilage. Some formulations, or at least those I personally use, combine it with an anti-inflammatory to have the benefits of both, but it can also be injected alone.

Many presentations come as three separate doses or one complete dose of six milliliters. The separate doses are two milliliters each and can be administered at intervals until the three doses are completed. Personally, I don’t like to give the patient three separate injections, so all three can be given in a single session with the same effect as buying the more expensive single dose. The goal is also to reduce inflammation and pain.

The timing for hyaluronic acid is more debatable than for the other two because it depends heavily on the severity and whether the knee is in an optimal condition for hyaluronic acid injection.

When is it used? It is used when there is wear and tear, not for meniscus injuries or certain knee pains, since that is not the indication for hyaluronic acid.

When to use it?

Depending on what is being sought, all patients must consider the severity of the wear and whether any of these types of infiltrations are appropriate — and, of course, the costs. The idea is to reduce pain and inflammation enough so that the patient can undergo physical therapy and carry out daily activities without discomfort. There will come a time when these infiltrations start to fail and become less effective as the wear problem progresses.