If you have knee pain and stiffness from arthritis or injury and are considering knee replacement, you might be able to avoid surgery with injection therapy. Many doctors, especially orthopedic surgeons, are offering what is generaly referred to as "knee programs" that combine a series of injections with physical therapy in order to rejuvenate old or injured knees.

As we age, we lose synovial fluid, the substance that supports cartilage and provides our joints with cushioning. With the knee program, synovial fluid in the form of Hyalgan, a hyaluronic acid, is injected directly into the knee, over a course of weeks. Typically, a physical therapist also works with patients to increase mobility and strength.

Before entering the program, your knee or knees will be x-rayed to determine if you're a good candidate. If your doctor decides the program could be beneficial for you, you'll be scheduled for several weeks of appointments. The average program is five weeks long, with one injection a week and three days a week of physical therapy. Some facilities also include electrotherapy and ultrasound heat therapy.

The injections involve little pain. First, the area will be sprayed with a numbing solution. Next, a numbing shot is given in the knee area. Then the doctor will inject the fluid, using x-ray guided technology. The entire process is no more painful that getting a flu shot.

This treatment is about 60-70% effective. While it doesn't work in every case, it is certainly worth investigating in order to possibly avoid painful, expensive knee replacement surgery. With the knee program, there's no "down time." Following the injection, your knee will be a little sore, but you'll be able to ambulate.

The beneficial effects from the knee program can last from six months to years. Some therapy patients never have to go through a second round.