What is osteoarthritis?
Some people who have constant pain in their knees have a condition called osteoarthritis, a degenerative joint disease. In osteoarthritis, the surface layer of cartilage breaks down and wears away. Adding to the problem, the synovial fluid in your knees loses its ability to lubricate the joint. This combination causes pain and stiffness, limitation of joint motion, and some inflammation in your knees.
What is viscosupplementation?
Viscosupplementation is a procedure in which a thick fluid called hyaluronate is injected into the knee joint. There are no cures for osteoarthritis, so viscosupplementation will not cure osteoarthritis of the knee. However, it is thought that hyaluronate will improve the lubricating properties of the synovial fluid, reduce the pain from osteoarthritis of the knee, improve mobility, and provide a higher and more comfortable level of activity.
How is viscosupplementation done?
This is typically a procedure performed in your doctor’s office. During the procedure, if there is any swelling in your knee, your doctor will remove (aspirate) the excess fluids before injecting the hyaluronic acid. Usually, this can be done at the same time, with only one needle injected into the joint, although some doctors may prefer to use two separate syringes. Depending on the product used, you will receive three to five injections, each 1 week apart.
How effective is viscosupplementation?
Many patients report feeling some pain relief during the 3- to 5-week course of the injections, while pain relief is delayed in others. Most patients report the greatest pain relief 8 to 12 weeks after beginning treatment. The length of pain relief varies; some patients have reported benefits for more than 6 months following the injections. Not all patients will have relief of pain. If the injections are effective they may be repeated after a period of time, usually 6 months. The long-term effectiveness of viscosupplementation is not yet known and research continues in this area.
What are the risks?
The most commonly reported side effects associated with the injections are temporary injection-site pain; swelling, heat, or redness; rash and itching; bruising around the joint; and fluid accumulation in the injected knee. These reactions are usually mild and don’t last long. As with steroid injections, infection and bleeding are possible though rare complications.
Who should not have viscosupplementation?
If you have had previous allergic reactions to sodium hylaluronate products, infections or skin diseases in the area where the injection will be given, or allergies to products from birds, such as feathers, eggs, and poultry, then you are not a candidate for viscosupplementation. The safety and effectiveness of viscosupplementation have not been established in pregnant women, women who are breastfeeding, or children.
What happens afterwards?
Hyaluronic acid does not have an immediate pain-relieving effect. For the first 48 hours after the shot, you should avoid excessive weight bearing on the leg, such as standing for long periods, jogging or heavy lifting. You may notice a local reaction, such as pain, warmth, and slight swelling immediately after the shot. These symptoms generally do not last long. You may want to apply an ice pack to help ease them. Rarely, patients may develop a local allergy-like reaction in the knee. In these cases, the knee may become full of fluid, red, warm, and painful. If this occurs, contact your doctor immediately.
Is viscosupplementation for you?
Viscosupplementation can be helpful for people whose arthritis has not responded to basic treatments. It is most effective if the arthritis is in its early stages (mild to moderate). This treatment is very effective for sports injuries and for athletes that love to run, bike, hike or participate in any sports that puts stress on the knees. It is also a great alternative to for people who are suffering from arthritis and would like to avoid knee replacement surgery. The viscosupplementation is covered by most insurances. Contact us to find out more!
At PrairieShore™ Pain Center, our goal is to relieve your pain and improve your quality of life. If your primary physician has advised you to see a specialist for your pain, turn to us for help. To schedule your appointment, please contact us here or give us a call at (847) 883-0077.
American Academy of Orthopaedic Surgeons. Viscosupplementation Treatment for Arthritis. OrthoInfo website 3/2014.