three shots and done?

[jonnylingo]

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Regarding knees and hips, the general practice as far as I was taught is: Inject up to three shots and then consider replacement. One exception is visco which I generally will repeat every 6 months as needed.

What is the reasoning behind 3 shots and done? Do you practice differently? More? Less? What if little old lady who doesn't want knee replacement likes her q6month injections? Is it reasonable to injection semiannually, even it that means 3+ shots?

 

[SSdoc33]

Regarding knees and hips, the general practice as far as I was taught is: Inject up to three shots and then consider replacement. One exception is visco which I generally will repeat every 6 months as needed.

What is the reasoning behind 3 shots and done? Do you practice differently? More? Less? What if little old lady who doesn't want knee replacement likes her q6month injections? Is it reasonable to injection semiannually, even it that means 3+ shots?

you were taught wrong.

 

[BobBarker]

I have a 100 year old I inject his knees with local only every 6 weeks. He is of sound mind and body and takes care of himself and his cows without issue.

 

[Ronin1]

It really depends on your patient population. If effective consider semi annual series as needed especially in older patients that don’t want replacement. Consider geniculate RF as well.

 

[willabeast]

Interesting question. I have been asking that question for all sorts of procedures for years. Only answer I ever got was "it depends".
I suspect that financial considerations play a major part in patient's wishes on these things. Other factors include patient's ability to tolerate surgery, rehab, life expectancy, competence of local surgeons, quality of local hospital or surgi-center in general, patient's previous experience with elective surgery.

 

[Ronin1]

Interesting question. I have been asking that question for all sorts of procedures for years. Only answer I ever got was "it depends".
I suspect that financial considerations play a major part in patient's wishes on these things. Other factors include patient's ability to tolerate surgery, rehab, life expectancy, competence of local surgeons, quality of local hospital or surgi-center in general, patient's previous experience with elective surgery.

Correct. It does depend on multiple factors. That’s why we don’t use algorithms for final treatment decisions

 

[geauxg8rs]

Correct. It does depend on multiple factors. That’s why we don’t use algorithms for final treatment decisions

algorithms are for nurses and insurance companies.

 

[AGDOC09]

If the joint injection is effective and lasts a reasonable amount of time (at least 3-4 months) then I will repeat if the patient wants to. I feel like knees and shoulders can last years with only semiannual injections. For whatever reason I feel like hips don’t last long on injections.

 

[jonnylingo]

you were taught wrong.

Care to elaborate?

 

[SSdoc33]

Care to elaborate?

where is it written that you can only do 3 shots?

in a patient that is amenable to a replacement, then 3 shots could be a guideline. it certainly isnt an absolute, and your decisions about shots vs other treatments should be guided by clinical judgement. there are many reasons why a patient may do very well with >3 injections.