Arthrosamid Injections

Arthrosamid is a form of injectable gel that can give some reduction in pain of osteoarthritic knee joints. The improvements are usually temporary but research has shown relief can last as long as several years in some patients. Arthrosamid injections are generally very safe, although occasionally patients may experience some side effects after treatment. The aim of page is to provide you with the necessary information regarding your treatment.

We ask all patients to provide written consent prior to booking an injection to ensure they have read and understood the information provided.

Whilst we do not require a doctor to refer you for an injection but we will supply you with a report after the procedure which we suggest you forward to your GP for your medical records.

Arthrosamid is a form of injectable gel that can give some reduction in pain of osteoarthritic knee joints. The improvements are usually temporary but research has shown relief can last as long as several years in some patients. Arthrosamid injections are generally very safe, although occasionally patients may experience some side effects after treatment. The aim of page is to provide you with the necessary information regarding your treatment.

We ask all patients to provide written consent prior to booking an injection to ensure they have read and understood the information provided.

Whilst we do not require a doctor to refer you for an injection but we will supply you with a report after the procedure which we suggest you forward to your GP for your medical records.

What are Arthrosamid injections and how are they used?

Arthrosamid is a hydrogel injection. Arthrosamid is licenced as a ‘medical device’ (similar to hyaluronic acid injections) because it is believed to provide relief through by physically cushioning the joint. Arthrosamid hydrogel does not degrade and therefore potentially provides longer lasting relief.

How do I know if Arthrosamid is appropriate for me?

Athrosamid is appropriate for people with osteoarthritis of the knee that are experiencing pain and swelling which may be affecting functions such as walking or running. We would always recommend first seeing a physiotherapist who can help you with appropriate exercise program, advise on footwear and conservative management. We usually recommend that you speak directly with one of our clinical specialists before booking. They may advise the need for an assessment before committing to the injection to ensure your knee is appropriate for an Arthrosamid injection. As part of this assessment process we will usually request people have had an X-ray or MRI scan of the knee within the last 12 months.

What happens when I book to have a Arthrosamid injection?

Prior to booking an appointment you will be asked to complete our on-line medical screening and consent form. This will ensure you have been medically screened and have all the appropriate information to make an informed decision about the treatment.

Once this has been screened you will be contacted to discuss and issues identified and to potentially make an appointment

Do I need to take prophylactic antibiotics before my Arthrosamid injection?

Due to manufacturers requirements Arthrosamid© must be administered with prophylactic antibiotics.

One of the following combination of oral antibiotics administered 1-2 hours before Arthrosamid are recommended:

1. For patients without allergy towards penicillin, 1g of Flucloxacillin plus 1g of Azithromycin

Or

2. For patients with known or suspect allergy towards penicillin, 600mg of Clindamycin plus 1g of Azithromycin

Or

3. 1g of Azithromycin plus 400mg Moxifloxacin

These antibiotics achieve adequate tissue concentrations at the time of injection. Used as a single-dose prophylaxis, they should exert a negligible impact on resistance development. Their spectrum encompasses members of the aerobic and anaerobic (i.e., deep) skin flora, which may contaminate the injection procedure, notably staphylococci, haemolytic streptococci, and Cutibacterium (former Propionibacterium) spp.

Dosages may need to be adjusted in patients with co-morbidities; hospital pharmacist advice should be sought if necessary.

What happens on the day of the Arthrosamid injection?

On the day of the procedure you are required to take the antibiotics 1-2 hours before the injection – see above. When booking it will be discussed whether you prefer to be sent the prescription in advance or attend the clinic early on the day to take the anti-biotics.

During the consultation the clinician will examine the knee and check the area to inject using diagnostic ultrasound. You will be given a local anaesthetic to the area that will be injected. If there is significant swelling of the knee this will usually be removed (aspirated) prior to the injection.

Your clinician will usually inject the Arthrosamid into the outside aspect of your knee (directly into the knee joint) using diagnostic ultrasound to precisely guide the injection. Arthrosamid is quite a thick (honey-like) substance and therefore can take a minute or two to administer.

What happens after the injection?

Due to the local anaesthetic your pain may be relieved within minutes, but the effect will usually wear off after an hour or two. It usually takes around 4 weeks for the effect of the Arthrosamid to become apparent. Pain and function will often continue to improve for a further 5 months before full benefits are being experienced.

We recommend you consider your journey home after your injection. This procedure includes the use of local anaesthetic injection around the knee. We recommend patient not to drive home after this procedure.

Patients are advised to avoid strenuous exercise (e.g. running, tennis or long walks) for 10-14 days afterward the injection. Your clinician will advise you on the day of the exact timeframe for your return to activities.

Will I need another injection?

Arthrosamid is designed to be used only once. Arthrosamid does not degrade and therefore designed to provide long term benefits.

Potential risks and side effects.

Most people receive Arthrosamid injections without any side effects. A full list of potential risks and side effects are listed below.

Post injection flare

Some people (around 20-30%) may have some pain for a few days after the injection (post injection flare). This can be managed with relative rest and over-the-counter painkillers. A much smaller proportion may have pain which will last for several weeks.

Very rarely patients experience a much more severe pain and swelling (known as pseudo-sepsis) which requires medical review to ensure no infection.

Will it hurt?

Patients receive a local anaesthetic to the area so the pain during the injection is usually quite minor. The local anaesthetic is given using a very fine needle so patients should feel only minor pain as this is adminitered. Arthrosamid is quite a thick (honey-like) substance and therefore can take a minute or two to administer.

Infection

Infection risk is reduced by taking the prophylactic anti-biotics – see above. However, very rarely (approximately 1:50,000 injections for joint generally) you may get an infection in the area of the injection. If the joint becomes more painful, hot and swollen, and/or you are feeling hot, nauseous and unwell you must seek medical attention immediately e.g., go to your local accident and emergency department (A&E). You should inform the medical professional examining you regarding your recent procedure and the details of the prophylactic anti-biotics you have taken before the procedure

To minimise this risk, the treating clinician will sterilize the area prior to injection and cover it with a plaster afterwards. It is important that you keep the injection site clean and dry until it has healed (normally 24 hours post injection). You can shower/wash in the 24 hours post injection but keep the area clean and apply a new plaster afterwards.

Anaphylaxis

It is extremely rare to have an allergic reaction to Arthrosamid or local anaesthetic (1:500,000). This would usually happen within the first few minutes of an injection and requires immediate medical attention. Very rarely the allergic reaction can be delayed. The symptoms you might experience are feeling lightheaded or faint, breathing difficulties (such as fast, shallow breathing and/or wheezing), a fast heartbeat, clammy skin, confusion and anxiety, collapsing or losing consciousness.

You will be asked to remain in the clinic for 20 minutes following the injection to allow observation of possible adverse reactions.

Other potential side effects

There are very few other reported side effects that have been linked with the use of Arthrosamid – please see below.

Can I take other medicines along with the Arthrosamid?

Yes, you can take other medications alongside having the Arthrosamid injection. There are no known significant drug interactions that occur with Arthrosamid. However, if you are taking a blood- thinning drug, such as Warfarin, you may need a blood test to make sure that your blood is not too thin to have the injection safely. This is because of the risk of bleeding into the joint at the time of the injection. If you are taking an anti-coagulant you may need to discuss this with your GP before having the injection.

Patients are required to take a prophylactic dose of anti-biotics 1-2 hours before the procedure. A separate patient information leaflet will be issued in relation to the anti-biotics

Pregnancy and breastfeeding

Unfortunately, we are not able to offer Arthrosamid injections to patients who are pregnant or breastfeeding. This is due of lack of robust research regarding safety.

Below is a summary of the risks/side effects from having Arthrosamid injection:

• Serious side effects are rare but can include:
• Joint and soft tissue infections.
• Anaphylaxis (allergic reaction) – to Anti-biotics, local anaesthetic or Arthrosamid hydrogel injection
• Very rarely severe pain and swelling (known as pseudo-sepsis) which requires medical assessment.

Other potential side effects include:

• Non-efficacy (the treatment may not work)
• Short lived efficacy (the treatment may work for a limited time)
• Post injection flare – usually mild and settles within few days. Occasionally more severe and lasts up to a week
• Swelling of Baker’s cyst may occur
• Long term worsening of symptoms
• Bleeding or bruising

Your clinician is highly trained and will take every appropriate step to avoid injecting or traumatising any soft tissue structures, nerves or vessels when performing the injection, however, there is always a very small risk that this could occur, particularly with injections at certain locations.

Potential side effects of local anaesthetics

Serious side effects are rare and include:

• Infection – (see also above)
• Anaphylaxis – (see also above)

Other potential side effects include:

• Light headedness
• Numbness of area injected
• Dizziness, drowsiness
• Blurred or double vision
• Vomiting
• Bradycardia
• Hypotension cardiac arrest
• Very rarely loss of consciousness, respiratory depression, respiratory or cardiac arrest.
• Allergic or anaphylactic reaction.
• Injury or trauma to neurovascular structures during the injection procedure.

Your therapist is highly trained and will take every appropriate step to avoid injecting or traumatising soft tissue structures, nerves or vessels when performing the injection. However, there is a very small risk that this can occur, particularly with injections at certain locations.

You will be asked to remain in the clinic for 20 minutes following the injection to allow observation for possible adverse reactions.

If you have any questions regarding the information contained in this leaflet, please call 02074823875 or email injections@complete-physio.co.uk and we will arrange for one of our clinical specialists to speak with you.

What are Arthrosamid injections and how are they used?

Arthrosamid is a hydrogel injection. Arthrosamid is licenced as a ‘medical device’ (similar to hyaluronic acid injections) because it is believed to provide relief through by physically cushioning the joint. Arthrosamid hydrogel does not degrade and therefore potentially provides longer lasting relief.

How do I know if Arthrosamid is appropriate for me?

Athrosamid is appropriate for people with osteoarthritis of the knee that are experiencing pain and swelling which may be affecting functions such as walking or running. We would always recommend first seeing a physiotherapist who can help you with appropriate exercise program, advise on footwear and conservative management. We usually recommend that you speak directly with one of our clinical specialists before booking. They may advise the need for an assessment before committing to the injection to ensure your knee is appropriate for an Arthrosamid injection. As part of this assessment process we will usually request people have had an X-ray or MRI scan of the knee within the last 12 months.

What happens when I book to have a Arthrosamid injection?

Prior to booking an appointment you will be asked to complete our on-line medical screening and consent form. This will ensure you have been medically screened and have all the appropriate information to make an informed decision about the treatment.

Once this has been screened you will be contacted to discuss and issues identified and to potentially make an appointment

Do I need to take prophylactic antibiotics before my Arthrosamid injection?

Due to manufacturers requirements Arthrosamid© must be administered with prophylactic antibiotics.

One of the following combination of oral antibiotics administered 1-2 hours before Arthrosamid are recommended:

1. For patients without allergy towards penicillin, 1g of Flucloxacillin plus 1g of Azithromycin

Or

2. For patients with known or suspect allergy towards penicillin, 600mg of Clindamycin plus 1g of Azithromycin

Or

3. 1g of Azithromycin plus 400mg Moxifloxacin

These antibiotics achieve adequate tissue concentrations at the time of injection. Used as a single-dose prophylaxis, they should exert a negligible impact on resistance development. Their spectrum encompasses members of the aerobic and anaerobic (i.e., deep) skin flora, which may contaminate the injection procedure, notably staphylococci, haemolytic streptococci, and Cutibacterium (former Propionibacterium) spp.

Dosages may need to be adjusted in patients with co-morbidities; hospital pharmacist advice should be sought if necessary.

What happens on the day of the Arthrosamid injection?

On the day of the procedure you are required to take the antibiotics 1-2 hours before the injection – see above. When booking it will be discussed whether you prefer to be sent the prescription in advance or attend the clinic early on the day to take the anti-biotics.

During the consultation the clinician will examine the knee and check the area to inject using diagnostic ultrasound. You will be given a local anaesthetic to the area that will be injected. If there is significant swelling of the knee this will usually be removed (aspirated) prior to the injection.

Your clinician will usually inject the Arthrosamid into the outside aspect of your knee (directly into the knee joint) using diagnostic ultrasound to precisely guide the injection. Arthrosamid is quite a thick (honey-like) substance and therefore can take a minute or two to administer.

What happens after the injection?

Due to the local anaesthetic your pain may be relieved within minutes, but the effect will usually wear off after an hour or two. It usually takes around 4 weeks for the effect of the Arthrosamid to become apparent. Pain and function will often continue to improve for a further 5 months before full benefits are being experienced.

We recommend you consider your journey home after your injection. This procedure includes the use of local anaesthetic injection around the knee. We recommend patient not to drive home after this procedure.

Patients are advised to avoid strenuous exercise (e.g. running, tennis or long walks) for 10-14 days afterward the injection. Your clinician will advise you on the day of the exact timeframe for your return to activities.

Will I need another injection?

Arthrosamid is designed to be used only once. Arthrosamid does not degrade and therefore designed to provide long term benefits.

Potential risks and side effects.

Most people receive Arthrosamid injections without any side effects. A full list of potential risks and side effects are listed below.

Post injection flare

Some people (around 20-30%) may have some pain for a few days after the injection (post injection flare). This can be managed with relative rest and over-the-counter painkillers. A much smaller proportion may have pain which will last for several weeks.

Very rarely patients experience a much more severe pain and swelling (known as pseudo-sepsis) which requires medical review to ensure no infection.

Will it hurt?

Patients receive a local anaesthetic to the area so the pain during the injection is usually quite minor. The local anaesthetic is given using a very fine needle so patients should feel only minor pain as this is adminitered. Arthrosamid is quite a thick (honey-like) substance and therefore can take a minute or two to administer.

Infection

Infection risk is reduced by taking the prophylactic anti-biotics – see above. However, very rarely (approximately 1:50,000 injections for joint generally) you may get an infection in the area of the injection. If the joint becomes more painful, hot and swollen, and/or you are feeling hot, nauseous and unwell you must seek medical attention immediately e.g., go to your local accident and emergency department (A&E). You should inform the medical professional examining you regarding your recent procedure and the details of the prophylactic anti-biotics you have taken before the procedure

To minimise this risk, the treating clinician will sterilize the area prior to injection and cover it with a plaster afterwards. It is important that you keep the injection site clean and dry until it has healed (normally 24 hours post injection). You can shower/wash in the 24 hours post injection but keep the area clean and apply a new plaster afterwards.

Anaphylaxis

It is extremely rare to have an allergic reaction to Arthrosamid or local anaesthetic (1:500,000). This would usually happen within the first few minutes of an injection and requires immediate medical attention. Very rarely the allergic reaction can be delayed. The symptoms you might experience are feeling lightheaded or faint, breathing difficulties (such as fast, shallow breathing and/or wheezing), a fast heartbeat, clammy skin, confusion and anxiety, collapsing or losing consciousness.

You will be asked to remain in the clinic for 20 minutes following the injection to allow observation of possible adverse reactions.

Other potential side effects

There are very few other reported side effects that have been linked with the use of Arthrosamid – please see below.

Can I take other medicines along with the Arthrosamid?

Yes, you can take other medications alongside having the Arthrosamid injection. There are no known significant drug interactions that occur with Arthrosamid. However, if you are taking a blood- thinning drug, such as Warfarin, you may need a blood test to make sure that your blood is not too thin to have the injection safely. This is because of the risk of bleeding into the joint at the time of the injection. If you are taking an anti-coagulant you may need to discuss this with your GP before having the injection.

Patients are required to take a prophylactic dose of anti-biotics 1-2 hours before the procedure. A separate patient information leaflet will be issued in relation to the anti-biotics

Pregnancy and breastfeeding

Unfortunately, we are not able to offer Arthrosamid injections to patients who are pregnant or breastfeeding. This is due of lack of robust research regarding safety.

Below is a summary of the risks/side effects from having Arthrosamid injection:

• Serious side effects are rare but can include:
• Joint and soft tissue infections.
• Anaphylaxis (allergic reaction) – to Anti-biotics, local anaesthetic or Arthrosamid hydrogel injection
• Very rarely severe pain and swelling (known as pseudo-sepsis) which requires medical assessment.

Other potential side effects include:

• Non-efficacy (the treatment may not work)
• Short lived efficacy (the treatment may work for a limited time)
• Post injection flare – usually mild and settles within few days. Occasionally more severe and lasts up to a week
• Swelling of Baker’s cyst may occur
• Long term worsening of symptoms
• Bleeding or bruising

Your clinician is highly trained and will take every appropriate step to avoid injecting or traumatising any soft tissue structures, nerves or vessels when performing the injection, however, there is always a very small risk that this could occur, particularly with injections at certain locations.

Potential side effects of local anaesthetics

Serious side effects are rare and include:

• Infection – (see also above)
• Anaphylaxis – (see also above)

Other potential side effects include:

• Light headedness
• Numbness of area injected
• Dizziness, drowsiness
• Blurred or double vision
• Vomiting
• Bradycardia
• Hypotension cardiac arrest
• Very rarely loss of consciousness, respiratory depression, respiratory or cardiac arrest.
• Allergic or anaphylactic reaction.
• Injury or trauma to neurovascular structures during the injection procedure.

Your therapist is highly trained and will take every appropriate step to avoid injecting or traumatising soft tissue structures, nerves or vessels when performing the injection. However, there is a very small risk that this can occur, particularly with injections at certain locations.

You will be asked to remain in the clinic for 20 minutes following the injection to allow observation for possible adverse reactions.

If you have any questions regarding the information contained in this leaflet, please call 02074823875 or email injections@complete-physio.co.uk and we will arrange for one of our clinical specialists to speak with you.