What should be discussed during a consult for a knee injection?

Key Elements to Discuss During a Knee Injection Consultation

During a knee injection consultation, healthcare providers should thoroughly discuss the procedure's benefits, risks, and expected outcomes using plain language and visual aids to ensure patient comprehension and informed consent. 1

Indication and Therapeutic Goals

• Clearly explain why the injection is recommended based on the patient's condition:

  • For osteoarthritis: Indicated for acute exacerbation of knee pain, especially with effusion 2
  • For rheumatoid arthritis: Consider when one or few residual active joints remain despite systemic therapy 2
  • For gout: Recommended as a first-line option for acute flares 2
  • For acute swelling: Ensure appropriate diagnosis has been made and contraindications ruled out 2

• Discuss realistic expectations:

  • Pain relief duration (typically weeks to months)
  • Functional improvement potential
  • Possibility of needing repeat injections 2, 1

Procedure Details

• Explain the injection technique:

  • Aseptic technique will be used (alcohol, iodine, or chlorhexidine skin preparation) 1
  • Position during procedure (typically on examination table) 2
  • Whether local anesthetic will be used (offer and explain pros/cons) 2, 1
  • Whether ultrasound guidance will be used to improve accuracy 2, 1
  • Duration of procedure (typically brief) 3

• Discuss medication to be injected:

  • For corticosteroid injections: Explain dose (typically 5-15mg for knee) 1, 4
  • For hyaluronic acid: Discuss limited benefits and cost considerations 2
  • For other injectables: Explain rationale if applicable 3, 5

Special Considerations

• For diabetic patients: Warn about risk of transient hyperglycemia for 1-3 days post-injection and need to monitor glucose levels 2, 1

• For patients on anticoagulants: Explain that injection is generally not contraindicated unless bleeding risk is exceptionally high 2, 1

• For pregnant patients: Discuss safety considerations for mother and baby 2

• For patients planning joint replacement: Inform that injection should be performed at least 3 months prior to surgery 2, 1

Post-Injection Instructions

• Activity recommendations:

  • Avoid overuse of the injected joint for 24 hours 2, 1
  • Complete immobilization is discouraged 2, 1
  • Normal activity can resume after 24 hours 1

• Pain management after injection:

  • Local pain at injection site is common and typically resolves within 24-48 hours 1
  • Ice may be used for comfort if needed 1

• Warning signs requiring medical attention:

  • Severe pain worsening after 48 hours
  • Increasing redness, warmth, or swelling
  • Fever or chills
  • Drainage from injection site 1

Follow-Up Plan

• Discuss timing for follow-up evaluation (typically 30 days) 1
• Address plan for potential repeat injections:
  • Consider benefits from previous injections
  • Generally avoid more than 3-4 glucocorticoid injections in the same joint per year 1
  • Discuss alternative treatment options if injections provide inadequate relief 2

Potential Complications

• Common side effects:

  • Temporary pain at injection site
  • Post-injection flare (temporary worsening of symptoms)
  • Skin/fat atrophy at injection site 4, 3

• Rare but serious complications:

  • Infection (rare at 0.035% but serious) 1
  • Cartilage damage with repeated injections 4
  • Tendon weakening/rupture 4

Contraindications

• Absolute contraindications:

  • Local infection at injection site
  • Bacteremia
  • Fracture 3, 6

• Relative contraindications:

  • Poorly controlled diabetes
  • Prosthetic joint (requires consultation with surgical team) 2, 1

By thoroughly addressing these elements during the consultation, healthcare providers can ensure patients are properly informed about knee injections, leading to better shared decision-making and potentially improved outcomes.