Pain Management Services
Joint injections, also known as intra-articular injections, are commonly performed in human and equine medicine for the treatment of osteoarthritis. For small animals, these injections are less often performed primarily due to lack of adequate understanding of their healing abilities and/or lack of formal training.
That said, VOSM specialists perform several hundred intra-articular injections annually. We recommend combining these injections with rehabilitation therapy as part of a conservative pain management plan.
Indications For Intra-Articular Injections In Dogs
- In conjunction with rehabilitation therapy as part of a conservative pain management plan
- Patients who have residual post-operative symptoms including effusion, discomfort or lameness and have not responded to medical management or rehabilitation therapy
- Patients whose bodies are intolerant of or non-responsive to non-steroidal anti-inflammatory medications (NSAIDs)
- As a supplement or alternative to oral medications
- Patients who have inflammatory joint disease
- Patients with progressively worse osteoarthritis
- To aid joint blocking for dogs who are lame but do not yet have a definitive diagnosis
At VOSM, we refer to four intra-articular products: hyaluronic acid, corticosteroids, stem cell therapy and platelet-rich plasma.
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.
Clinical Response to Hyaluronic Acid
More than six months of osteoarthritis pain relief
Study from Vet Record demonstrated that:
70% of dogs who had intra-articular HA injections responded well
20% responded fair
10% did not respond
For dogs who do not respond to intra-articular HA injections, corticosteroids are recommended (Depo-Medrol® or Triamcinolone).
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 & Corticosteroids When Treating Patients With Osteoarthritis
1) Mild Osteoarthritis and Synovitis
Hyaluronic Acid: once a week for three weeks
2) Moderate Osteoarthritis or Non-responsive to Hyaluronic Acid
Triamcinolone: once, followed by another injection two weeks later if needed
3) Severe Osteoarthritis
Depo-Medrol: once, followed by another injection three weeks later if needed
Stem Cell Therapy
Clinical Response To Stem Cell Therapy In Osteoarthritis Patients
Significant improvement in lameness
Increased range of motion
Significant difference in client evaluation score (Cincinnati Orthopedic Disability Index)
For more information about stem cell therapy, visit our Center for Regenerative Medicine.
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 Who Have Benefitted From PRP
Hines Ward and Troy Polamalu (NFL)
Takashi Saito and Jose Reyes (MLB)
Kobe Bryant (NBA)
~20 Professional Soccer Players
For more information about platelet-rich plasma, visit our Center for Regenerative Medicine.