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Injections for osteoarthritis in knees

Camino(s) past & future
Camino Frances 2015, Camino Portugues 2017, Camino Finisterre 2017, Le Puy Route (Sept. 2018)
#1
I am starting the Camino next April. I have osteoarthritis in both knees but have been able to walk the Camino Francis and Camino Portugués in the last couple of years. Recently my knees have been quite painful even after walking just ten kilometres so I visited an orthopaedic surgeon and he said I was eventually heading towards partial knee replacements but suggested I try Durolane hydraulic acid injections in the knees a month or so before I begin the Camino. Has anyone had these injections and what results did they achieve? Looking forward to any opinions as I’d hate to break down a few days in.
 
Camino(s) past & future
Frances (2015); Ch. d'Arles: Oloron Ste Marie to Aragones; Frances (2016); V.d.l.P.; Sanabres (2017)
#2
I have had several injections in my bad knee: two corticosteroid injections and one injection of an unknown gel to replace lost synovial fluid in the knee. None had any effect whatsoever, except that the second type of injection relieved me of about $450. I recommend getting the injections ahead of time, so you know what, if any, effect they have. But don't rely on them until you try them, because they are not always predictable. If your doctor recommends to get them a month before you leave, you might want to get one at a time with a short delay between. But I don't really know if failure to help in one knee necessarily predicts failure in the other as well. I have heard of many others who have had coricosteroid injections and they worked for them. But I do not know anyone who had a successful injection of the other type of injection to replace the synovial fluid. I suspect that the corticosteroid injections are more common. To sum up, I am not an advertisement for any sort of relief of knee pain, except diclofenac in gel form, applied to the knee and naproxen by mouth. If you want a stronger form of diclofenac gel than Voltaren, ask your doctor for a prescription.
Vimovo is a fairly new form of naproxen, stronger than the usual pills and with an added medication to prevent stomach problems with naproxen. This is what I take on camino, and I find it very useful. But it is on prescription in Canada and relatively expensive. Perhaps if the injection does not work for the first knee you could ask him about Vimovo. Good luck.
 

Cayou

Active Member
Camino(s) past & future
2015 Villafranca to Santiago
2016 St Jean to Los Arcos
2018 24-Sept Leon to Finnisterre
#3
I am starting the Camino next April. I have osteoarthritis in both knees but have been able to walk the Camino Francis and Camino Portugués in the last couple of years. Recently my knees have been quite painful even after walking just ten kilometres so I visited an orthopaedic surgeon and he said I was eventually heading towards partial knee replacements but suggested I try Durolane hydraulic acid injections in the knees a month or so before I begin the Camino. Has anyone had these injections and what results did they achieve? Looking forward to any opinions as I’d hate to break down a few days in.
I spoken with a few others who have had the HA injections with really good success. Think it only last about 1 year but worth the $950-$1500, or ? price. I take HA capsules every day as a preventative, can't say apples to apples if it has helped, but my knees are fine, so far, so it hasn't hurt. Good luck with any treatment and your Camino!
 

nathanael

Active Member
Camino(s) past & future
Via de la Plata
#4
I spoken with a few others who have had the HA injections with really good success. Think it only last about 1 year but worth the $950-$1500, or ? price. I take HA capsules every day as a preventative, can't say apples to apples if it has helped, but my knees are fine, so far, so it hasn't hurt. Good luck with any treatment and your Camino!
I had it done and it didn't work for me. I have arthritis in both knees. What has worked for me is getting an injection of cortisone a month before I go and it lasts a whole year for me.
 
Camino(s) past & future
Camino Frances 2015, Camino Portugues 2017, Camino Finisterre 2017, Le Puy Route (Sept. 2018)
#5
I had it done and it didn't work for me. I have arthritis in both knees. What has worked for me is getting an injection of cortisone a month before I go and it lasts a whole year for me.
Did you go to your GP or did you have to go to an orthopaedic specialist for the injection?
 

Via2010

Active Member
Camino(s) past & future
06/07 & 12 Camino Francés, 08-10 Via de la Plata, 13/14 & 17 Camino Portugués, 18 Camino Primitivo
#6
My husband had HA-injections in his knees and thinks they are helpful. So it is worth a try.

Another option is to change your diet. On my camino to Muxía I walked with a french lady, Bernadette. She had very bad knees several years ago. She was not even able to move within her flat and do her household without crutches. By a surgeon she was reccomended to have both knees replacest. Instead she went to another doctor, who suggested her to change her diet. Basically this meant: no gluten, no milk (lactose), lots of vegetables, some beef twice a week and fat fish (salmon, herring, macarel....) three times a week, no or only very little alcohol. Her knees recovered and she had been able to walk the entire Norte without pain. As I walked the whole 30 km from Fisterra to Muxía in her company, I can tell you that I did not think that she had an issue with her knees anymore. If I were you I would try that diet.

BC Alexandra
 

jozero

Oh... That's what the shell is for...
Camino(s) past & future
CF January 2013
CF April 2016
CF January 2018
CP Coastal September 2018
#7
I gave it a try and like Albertagirl just found myself $500 poorer. For me cortisone was the only injection that helped and usually lasts me around 10-12 months. I know it is not a forever solution but will get as many years as I can out if it. Good luck!
 
Camino(s) past & future
C. Francés (2004-), C. Portugués, C. de Madrid, 1/2 V. Plata, 1/8 Levante, hospitalera Grado 2016.
#8
Oral diclofenac helped me a lot - but is the only risk factor my physicians can find for the stroke I had back in March, so I wouldn't recommend it...
 
Camino(s) past & future
2013, 2014
#10
As a physician I have no qualms about giving medical advice :) so here it is.

1) Everybody's knee conditions will be slightly different; it really is in your interest to have a specialist (orthopedist) examine you, get XRays, MRI, etc to try to delineate the source of your pain problem

2) Based on that, any of the above mentioned treatments (oral non-steroidal anti-inflammatory meds (Diclofenac, Ibuprofen, Celebrex, Arcoxia, etc), corticosteroid injections into the joint, hyaluronic injections, various preparations of stem cell injections, etc are all shown to work in some people but not in others.

Be careful of the "anecdotal fallacy" where one person's experience (an anecdote) is generalized to pertain to a larger population ~ that is NOT the case. "X medication worked for me, so...." Or "Y treatment caused me to have this reaction, so..." Those are of limited value and are often misleading. You really have to look at studies done on large numbers of people ~ some will get relief, some will not, a small percentage will have an adverse reaction, etc....

3. Strengthening the muscles, etc around the knee can work wonders to relieve knee pain, even in osteoarthritis. Step ups, squats, lunges etc are *not* necessarily off limits but again, you need to be under the supervision of a qualified physical therapist or exercise physiologist or athletic trainer. Many orthopedic docs do not ascribe to this but I can tell you it definitely has value.

4. Dietary changes. Anti-inflammatory diets (and what's the definition of that?:)) do work. One example would be a strict vegan diet and no gluten (some include no alcohol or caffeine for no good reason that I have ever heard but keep them in small quanities). Try 5-7 days on that diet. It can be miracle working but is hard to sustain.

My advice is seek a good professional to establish the degree of arthritis, etc, pick a plan to follow, do good PT and exercise for the knee, try dietary changes. And recognize that the plan you begin with (oral medications, X injection, Y injection, etc) will be trial and error; you will change the plan as you see what works and what doesn't. Try not to spend too much money (exercise and dietary changes are perhaps the least expensive and the best for you)

Good Luck!
 
Camino(s) past & future
Frances (2015); Ch. d'Arles: Oloron Ste Marie to Aragones; Frances (2016); V.d.l.P.; Sanabres (2017)
#11
My advice is seek a good professional to establish the degree of arthritis, etc, pick a plan to follow, do good PT and exercise for the knee, try dietary changes. And recognize that the plan you begin with (oral medications, X injection, Y injection, etc) will be trial and error; you will change the plan as you see what works and what doesn't. Try not to spend too much money (exercise and dietary changes are perhaps the least expensive and the best for you)
@Constantine
From a patient's point of view, I agree totally. But physiotherapy is not inexpensive in Canada, and I hate exercising. I don't mind too much spending thousands of dollars on my teeth (a recent necessity) but spending hundreds on physiotherapy seems both expensive and futile. I have tried it with no results, except for a diminution in my bank account. However, I admit that my hatred of exercise, except for walking 1,000 km on camino, which I like just fine, may have caused me to be less faithful to the exercises or less persistent. What I end up with is the admission that I like eating a lot more than I like exercising, and am more eager to keep in shape for it.
 
Camino(s) past & future
2013, 2014
#12
@Constantine
From a patient's point of view, I agree totally. But physiotherapy is not inexpensive in Canada, and I hate exercising. I don't mind too much spending thousands of dollars on my teeth (a recent necessity) but spending hundreds on physiotherapy seems both expensive and futile. I have tried it with no results, except for a diminution in my bank account. However, I admit that my hatred of exercise, except for walking 1,000 km on camino, which I like just fine, may have caused me to be less faithful to the exercises or less persistent. What I end up with is the admission that I like eating a lot more than I like exercising, and am more eager to keep in shape for it.
PT is not futile and if you don't do the exercises consistently they won't work for you. If physiotherapy is too expensive, you can find lots of good sites online for free with videos and gif's of exercises to do for your knees. But if you don't want to do them, then its not a good option for you. My job is to offer alternative therapies, of which there are several. Its totally up to you to choose which ones, if any, you would like to do. Good Luck!
 
Camino(s) past & future
Camino Frances 2015, Camino Portugues 2017, Camino Finisterre 2017, Le Puy Route (Sept. 2018)
#13
As a physician I have no qualms about giving medical advice :) so here it is.

1) Everybody's knee conditions will be slightly different; it really is in your interest to have a specialist (orthopedist) examine you, get XRays, MRI, etc to try to delineate the source of your pain problem

2) Based on that, any of the above mentioned treatments (oral non-steroidal anti-inflammatory meds (Diclofenac, Ibuprofen, Celebrex, Arcoxia, etc), corticosteroid injections into the joint, hyaluronic injections, various preparations of stem cell injections, etc are all shown to work in some people but not in others.

Be careful of the "anecdotal fallacy" where one person's experience (an anecdote) is generalized to pertain to a larger population ~ that is NOT the case. "X medication worked for me, so...." Or "Y treatment caused me to have this reaction, so..." Those are of limited value and are often misleading. You really have to look at studies done on large numbers of people ~ some will get relief, some will not, a small percentage will have an adverse reaction, etc....

3. Strengthening the muscles, etc around the knee can work wonders to relieve knee pain, even in osteoarthritis. Step ups, squats, lunges etc are *not* necessarily off limits but again, you need to be under the supervision of a qualified physical therapist or exercise physiologist or athletic trainer. Many orthopedic docs do not ascribe to this but I can tell you it definitely has value.

4. Dietary changes. Anti-inflammatory diets (and what's the definition of that?:)) do work. One example would be a strict vegan diet and no gluten (some include no alcohol or caffeine for no good reason that I have ever heard but keep them in small quanities). Try 5-7 days on that diet. It can be miracle working but is hard to sustain.

My advice is seek a good professional to establish the degree of arthritis, etc, pick a plan to follow, do good PT and exercise for the knee, try dietary changes. And recognize that the plan you begin with (oral medications, X injection, Y injection, etc) will be trial and error; you will change the plan as you see what works and what doesn't. Try not to spend too much money (exercise and dietary changes are perhaps the least expensive and the best for you)

Good Luck!
Thanks for the advice.
 
Camino(s) past & future
Frances (2015); Ch. d'Arles: Oloron Ste Marie to Aragones; Frances (2016); V.d.l.P.; Sanabres (2017)
#14
@Constantine
Thank you. Thinking back, I believe that the leg lifts did help. As my quads strengthened I think that the kneecap lifted off the painful surface underneath. My unfortunate insistence on all or nothing left me choosing between continuing all the tedious and time-consuming exercises, since most seemed to be doing no good and I was uncertain whether it was a wise practice to pick and choose between a physiotherapist's list of exercises. But I am going back to doing leg lifts once or twice a day and see how that affects the pain on my longer walks. I like your comment that it is up to the suffering person to choose what to do.
 

Yctoo

New Member
Camino(s) past & future
Camino ingles (2018)
#15
I had it done and it didn't work for me. I have arthritis in both knees. What has worked for me is getting an injection of cortisone a month before I go and it lasts a whole year for me.
I also had cortisone injections in my knee last June. Made a huge difference. Walked the Camino Ingles in October and still feeling great
 

Yctoo

New Member
Camino(s) past & future
Camino ingles (2018)
#16
I had it done and it didn't work for me. I have arthritis in both knees. What has worked for me is getting an injection of cortisone a month before I go and it lasts a whole year for me.
I also had cortisone injections in my knee last June. Made a huge difference. Walked the Camino Ingles in October and still feeling great
 

nathanael

Active Member
Camino(s) past & future
Via de la Plata
#17
I spoken with a few others who have had the HA injections with really good success. Think it only last about 1 year but worth the $950-$1500, or ? price. I take HA capsules every day as a preventative, can't say apples to apples if it has helped, but my knees are fine, so far, so it hasn't hurt. Good luck with any treatment and your Camino!
what are HA capsules?
 

JabbaPapa

"True Pilgrim"
Camino(s) past & future
100 characters or fewer : see signature details
#19
I am starting the Camino next April. I have osteoarthritis in both knees but have been able to walk the Camino Francis and Camino Portugués in the last couple of years. Recently my knees have been quite painful even after walking just ten kilometres so I visited an orthopaedic surgeon and he said I was eventually heading towards partial knee replacements but suggested I try Durolane hydraulic acid injections in the knees a month or so before I begin the Camino. Has anyone had these injections and what results did they achieve? Looking forward to any opinions as I’d hate to break down a few days in.
Good advice, though you should also work incessantly towards at least trying to build up muscle mass and tone, and to keep your weight down as much as possible.

And it's hyaluronic acid.

My understanding is that the effects can vary from person to person, but most people will feel at least some benefit -- depending mainly on how far gone the condition may be.

But from my experience, these injections are most helpful first time 'round, so you should have positive results -- but usually, it's a series of three injections into each knee at a distance of about a week between each, so it would be better to start the treatment at least two months before leaving.

You should avoid cortisone injections, because in the long run, even though it provides quick pain relief, the substance just ends up damaging the cartilage even further. The relief is also usually of much shorter duration than with the hyaluronic acid (but as always, individual cases will vary).

You can try glucosamine as a food supplement BTW -- this one definitely does NOT work for everyone (seems only about 60% have reported any benefit at all from it), and when it does the relief is usually minimal (but every bit helps), although there have been a very small number of rare cases where it has been observed to help in cartilage regeneration.
 
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JabbaPapa

"True Pilgrim"
Camino(s) past & future
100 characters or fewer : see signature details
#20
Another option is to change your diet. On my camino to Muxía I walked with a french lady, Bernadette. She had very bad knees several years ago. She was not even able to move within her flat and do her household without crutches. By a surgeon she was reccomended to have both knees replacest. Instead she went to another doctor, who suggested her to change her diet. Basically this meant: no gluten, no milk (lactose), lots of vegetables, some beef twice a week and fat fish (salmon, herring, macarel....) three times a week, no or only very little alcohol. Her knees recovered and she had been able to walk the entire Norte without pain. As I walked the whole 30 km from Fisterra to Muxía in her company, I can tell you that I did not think that she had an issue with her knees anymore. If I were you I would try that diet.
Diet recommendations are difficult, as there appears to be more and more evidence that there is no one-size-fits-all magic bullet diet for one and for all.

What's been working for me, is the carnivore diet, and if I hadn't started following it about 4 months ago, my upcoming Camino would probably still be impossible.

Nevertheless, there do seem to be a few universal principles, including that the Mediterranean diet appears to be the only diet that could be referred to as a basic universal diet type that all could follow, including all variants between the strongly vegetarian and the strongly carnivorous.

But there are a couple of others, which are more based on how the cellular mitochondria turn food into either energy or body fat.

As a general rule, animal fat is THE best source of energy (the body metabolises it with far greater efficiency than anything else), so fat, lard, bacon, sausages, pâtés, and for the non-lactose-intolerant, cheeses and non-diet yoghurts (greek yoghurt being the best type ; 0% fat dairy products to be completely avoided).

Then, assuming no diabetes --- first, avoid all sugar, and vegetable oils (except olive and avocado oil), most fructose (including fruit out of season ; but berries like strawberry, blackberry, raspberry are basically fine), avoid oranges in particular, ALL fruit juices absolutely, avoid ALL soy products (they're actually worse than refined white sugar at the biochemical level), and generally try and avoid cereals, but wheat especially.

Whether gluten should be or need not be avoided seems to be quite variable from person to person, but if a doctor suggests it, then do so.

I would NOT recommend my own carnivore diet, which isn't even of the most extreme variety, to anyone except as a last resort if nothing else seems to have worked.
 
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nathanael

Active Member
Camino(s) past & future
Via de la Plata
#21
I gave it a try and like Albertagirl just found myself $500 poorer. For me cortisone was the only injection that helped and usually lasts me around 10-12 months. I know it is not a forever solution but will get as many years as I can out if it. Good luck!
I totally agree with you it does last and on the Camino, it flares up at times but I use an ointment I buy in Spain called Radio Salil. You have to ask for it cause it's not displayed.
 

markgrubb

New Member
Camino(s) past & future
Camino Frances 2016, Hospitalero 2017 Camino del Norte (2017)
#22
In addition to the practical advice given by Constatine there was an evaluation done of HA injections looking at 11 trials. This showed that the injection provised a modest improvement in pain relief and joint range of movement for up to around 9 months with no real significant side effects. Some people respond well and some don’t at all. So it is reasonable to try it along with a structured plan of exercises.
 

vwzoo

New Member
Camino(s) past & future
2018
#23
I am starting the Camino next April. I have osteoarthritis in both knees but have been able to walk the Camino Francis and Camino Portugués in the last couple of years. Recently my knees have been quite painful even after walking just ten kilometres so I visited an orthopaedic surgeon and he said I was eventually heading towards partial knee replacements but suggested I try Durolane hydraulic acid injections in the knees a month or so before I begin the Camino. Has anyone had these injections and what results did they achieve? Looking forward to any opinions as I’d hate to break down a few days in.
I am 56 and I walked the Camino Frances from St Jean to Fisterra last September after having both of my knees replaced in 2011. I had those shots in my knees the years before replacement and they didn't help, but they were quite painful to get. Maybe they work for some and I was willing to give them a shot, but they did nothing for me.
 

nathanael

Active Member
Camino(s) past & future
Via de la Plata
#24
I am 56 and I walked the Camino Frances from St Jean to Fisterra last September after having both of my knees replaced in 2011. I had those shots in my knees the years before replacement and they didn't help, but they were quite painful to get. Maybe they work for some and I was willing to give them a shot, but they did nothing for me.
I am able to walk the whole Camino with just injection of cortisone in both knees, as well the other injections didn't do it for me. my orthopedic specialist will not do a knee replacement states will not help. nevertheless, everyone do what you can. I plan on being out there in 2019. me
 

JabbaPapa

"True Pilgrim"
Camino(s) past & future
100 characters or fewer : see signature details
#25
I had those shots in my knees the years before replacement and they didn't help, but they were quite painful to get. Maybe they work for some and I was willing to give them a shot, but they did nothing for me.
As far as I know, they tend not to work well on those with the more severe damage.
 

KariC

Active Member
Camino(s) past & future
Caminho portugûes (2016)
#26
I am starting the Camino next April. I have osteoarthritis in both knees but have been able to walk the Camino Francis and Camino Portugués in the last couple of years. Recently my knees have been quite painful even after walking just ten kilometres so I visited an orthopaedic surgeon and he said I was eventually heading towards partial knee replacements but suggested I try Durolane hydraulic acid injections in the knees a month or so before I begin the Camino. Has anyone had these injections and what results did they achieve? Looking forward to any opinions as I’d hate to break down a few days in.
I got many of those injections in my knee, about every 6-9 months, for years before getting my replacement. Excellent results - within a day or two I'd be back to walking without pain, and they last for months.
 
Camino(s) past & future
CF - April/May 2017
CP Central - Sep./2017
CP Coastal - Sep./2018
#27
I have a bad knee, ACL reconstruction done years ago, partial meniscus tear, minimal cartilage. I wear a rigid knee brace for any hiking and other activity. My sports medicine doctor thinks I am too young at 50 for a knee replacement ???

3 OPTIONS I EXPLORED:
I had a cortisone shot that worked well for about 4 months and got me through the CF without much problem. A bit of Advil (reduces swelling) and Tylenol (pain relief) some nights to help a bit - and some Vino Tinto too.

But, after walking about 1,500 kms over 6 months my knee was down to about 50% strength at best. I received a 2nd cortisone shot but it did not seem to help.

My doctor then suggested trying either a synthetic lubricant injection or a "PRP" (Platelet Replacement Plasma) injection - each one was about $425. He thought the PRP was a better "gamble" so I tired it and happy I did.

I will try to explain PRP as a non-medical person - For the "PRP" (Platelet Replacement Plasma) injection they take some blood out of your arm in a vile, spin it in a machine to separate the plasma which is milky colour. Then they re-inject that same plasma into your knee. I had some short-term relief in about 2 weeks and significant relief within 6 weeks. Very pleased 9 months later. My knee is about 75% and I am back to playing ice hockey. I also walked another 270 kms on the CP 2 months ago, I still wear the rigid knee brace for any vigorous activity. I have been told that I may need to do the PRP shot once a year which would be ok by me if it keep working.

The Doctor reminds me that I have to keep the heat and swelling down so I use ice and take Naproxen or Advil as needed. Careful, these can be hard on your kidneys. Best wishes.
 

RobertB

New Member
Camino(s) past & future
May 2018
#28
I walked the CF May-June 2018 and will walk it again May 2019. I had knee issues when training 6 mos before the walk. The Ortho Surgeon injected the HA (both knees over 3 weeks) a month before my walk. I had no problem with knee issues (tested first day from St JPDP). I will have the injections again before the walk since I am 69 and have thin cartilage. I do several century (100 miles) rides (MS 150) each yr with no knee issues. I also wear a velcro knee brace which straps above and below front of knee for added support when training with full backpack or walking across Spain. Would love to hear others experiences. PS if your my age you may consider cycling at home, its LOW impact and aerobic.
 
Camino(s) past & future
Camino Frances 2015, Camino Portugues 2017, Camino Finisterre 2017, Le Puy Route (Sept. 2018)
#30
I am able to walk the whole Camino with just injection of cortisone in both knees, as well the other injections didn't do it for me. my orthopedic specialist will not do a knee replacement states will not help. nevertheless, everyone do what you can. I plan on being out there in 2019. me
I am able to walk the whole Camino with just injection of cortisone in both knees, as well the other injections didn't do it for me. my orthopedic specialist will not do a knee replacement states will not help. nevertheless, everyone do what you can. I plan on being out there in 2019. me
I am able to walk the whole Camino with just injection of cortisone in both knees, as well the other injections didn't do it for me. my orthopedic specialist will not do a knee replacement states will not help. nevertheless, everyone do what you can. I plan on being out there in 2019. me
Did the cortisone injections eventually cause any further damage to your knees? My doctor advised me against them and the orthopaedic specialists suggested it was an alternative to Synvisc but can cause further damage to ligaments and cartilage etc. He described it as a “smart bomb”. i’m certainly tempted because they are a lot less expensive.
 

JabbaPapa

"True Pilgrim"
Camino(s) past & future
100 characters or fewer : see signature details
#31
I have a bad knee, ACL reconstruction done years ago, partial meniscus tear, minimal cartilage. I wear a rigid knee brace for any hiking and other activity. My sports medicine doctor thinks I am too young at 50 for a knee replacement ???
I developed my own condition while I was still in my 40s -- so, definitely too young for me !!

But then, I walked from Lourdes to Compostela in 2014 -- and whilst my knee braces were an absolute necessity during the year of training before that Camino, three days after praying for healing at the Grotto, I just put them in my backpack and basically haven't used them since.

The only real solution is damage prevention, except for those poor people with the actually degenerative variants of these conditions, but of course that advice will typically fall on the deaf ears of those whose knees still work perfectly OK.

Meat-and-fat-centric dieting can help some people, but apart from some still highly expensive stem cell treatments that can regenerate the damaged cartilage, there's no magic bullet solution.
 

JabbaPapa

"True Pilgrim"
Camino(s) past & future
100 characters or fewer : see signature details
#32
Did the cortisone injections eventually cause any further damage to your knees? My doctor advised me against them and the orthopaedic specialists suggested it was an alternative to Synvisc but can cause further damage to ligaments and cartilage etc. He described it as a “smart bomb”. i’m certainly tempted because they are a lot less expensive.
AFAIK, cortisone injections can be OK once or twice as an "emergency" treatment, but it's repetitive injections that end up damaging the cartilage.
 
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