Name of the Procedure:

Injection of Triamcinolone Acetonide, Preservative-Free, Extended-Release, Microsphere Formulation (also known as Zilretta, HCPCS code J3304).

Summary

This procedure involves an injection of a long-acting corticosteroid medication designed to reduce inflammation and provide pain relief. Specifically, it is a preservative-free and extended-release formulation of triamcinolone acetonide, delivered in microspheres to sustain drug release over time.

Purpose

The injection is primarily used to treat inflammation and pain associated with conditions like osteoarthritis. The goal is to reduce pain and improve joint function over an extended period, potentially mitigating the need for more frequent injections.

Indications

The procedure is indicated for:

• Osteoarthritis of the knee
• Patients experiencing chronic joint pain
• Inflammation not responsive to other treatments

Patient criteria:

• Adults with osteoarthritis
• Patients who have not found relief with other conservative treatments like physical therapy or oral medications

Preparation

Patients are generally advised to:

• Notify the provider of any allergies, especially to steroids or medications.
• Discuss current medications, as some may need to be paused or adjusted.
• No special fasting is usually required.

Pre-procedure assessments:

• Physical examination of the affected joint
• Diagnostic imaging like X-rays or MRI, if deemed necessary

Procedure Description

1. The patient is positioned comfortably, exposing the affected joint.
2. The skin over the injection site is cleaned with antiseptic.
3. A local anesthetic may be applied to minimize discomfort.
4. Triamcinolone acetonide is then injected directly into the joint space using a syringe and needle.
5. Pressure is applied to the injection site to prevent bleeding.

No general anesthesia or sedation is typically required, though numbing the injection site is common.

Duration

The procedure itself is brief, typically taking about 15-30 minutes.

Setting

The injection is administered in an outpatient setting, such as a doctor’s office, outpatient clinic, or an outpatient department of a hospital.

Personnel

• Physician or Nurse Practitioner: Administers the injection.
• Nurse: Assists with preparation and post-procedure care.

Risks and Complications

Common risks:

• Pain at the injection site
• Swelling or redness
• Temporary increase in joint pain

Rare complications:

• Infection
• Allergic reaction
• Tendon weakening or rupture

Complication management:

• Monitor for signs of infection.
• Address allergic reactions with appropriate medications.
• Physical therapy to manage tendon issues.

Benefits

• Reduced joint pain and inflammation
• Improved joint function
• Potentially fewer injections due to extended-release formulation

Benefits onset:

• Pain relief can be noticed within a few days, lasting for several weeks to months.

Recovery

Post-procedure care:

• Patients may be advised to rest the joint for 24 hours.
• Ice packs can help reduce inflammation at the injection site.

Expected recovery time:

• Most patients return to normal activities within 1-2 days.
• Follow-up appointments may be scheduled to assess the efficacy of the injection and plan further treatment if needed.

Alternatives

• Oral or topical NSAIDs
• Physical therapy
• Other injectable corticosteroids
• Hyaluronic acid injections
• Surgery in severe cases

Pros and cons:

• Oral NSAIDs may be less effective in severe cases but easier to administer.
• Physical therapy is beneficial but may not provide quick relief.
• Other corticosteroid injections might require more frequent administration.
• Surgery is more invasive with longer recovery but offers a more permanent solution.

Patient Experience

During the procedure:

• Mild discomfort or a brief stinging sensation.

After the procedure:

• Some soreness or swelling at the injection site, which typically resolves within a couple of days.
• Pain management includes using ice packs and over-the-counter pain relief if needed.
• Patients are generally able to resume normal activities shortly after the injection.