Knee Viscosupplementation

When knee discomfort progresses beyond a mere inconvenience, accompanied by swelling, tenderness, or inflammation, seeking professional intervention becomes imperative.

At Complete Orthopedics, we specialize in addressing knee pain associated with bursitis through tailored treatment plans and innovative approaches such as viscosupplementation. Our focus lies in comprehensively assessing your symptoms, pinpointing the underlying issue, and proposing the most suitable course of action to alleviate discomfort or pursue surgical correction.

With convenient locations in New York City and Long Island, coupled with affiliations with six hospitals, we boast cutting-edge facilities for advanced orthopedic care and knee surgeries, including viscosupplementation procedures. Scheduling a consultation with one of our orthopedic surgeons is hassle-free—simply book online or via phone.

Explore the diverse causes and treatment options for knee pain, and ascertain whether viscosupplementation or other interventions present the optimal solution for your situation.

Overview 

Knee pain can be debilitating, affecting our ability to move freely and enjoy daily activities. Fortunately, advancements in medical science offer various treatments to alleviate discomfort and improve knee function. One such treatment gaining attention is viscosupplementation. In this comprehensive guide, we’ll break down the science behind viscosupplementation in easy-to-understand language, exploring its benefits, risks, and how it could potentially help you find relief from knee pain.

During the development of knee osteoarthritis, the normal fluid within the knee (known as synovial fluid) loses its viscosity due to a decrease in its proteoglycan content. This, along with numerous other factors, contribute to the development and worsening of knee osteoarthritis.

X-ray showing osteoarthritis of the knee.

X-ray showing osteoarthritis of the knee.

 

What is Viscosupplementation?

Viscosupplementation is a minimally invasive procedure used to treat knee osteoarthritis, a condition where the cartilage in the knee joint breaks down over time, causing pain and stiffness. Unlike surgical interventions like knee replacement, viscosupplementation involves injecting a gel-like substance called hyaluronic acid directly into the knee joint.

 

Understanding Knee Osteoarthritis

Before delving into how viscosupplementation works, let’s understand knee osteoarthritis. Think of your knee joint as a well-oiled machine, where smooth cartilage allows bones to glide over each other effortlessly. With osteoarthritis, this cartilage wears away, leading to friction between bones, inflammation, and pain.

 

How Does Viscosupplementation Work?

Hyaluronic acid, the key ingredient in viscosupplementation, is a naturally occurring substance found in the synovial fluid that lubricates our joints. When injected into the knee, it acts as a lubricant and shock absorber, reducing friction between bones and providing relief from pain.

 

The Procedure

Viscosupplementation is typically performed as an outpatient procedure in a doctor’s office or clinic. The process involves cleansing the knee area and injecting the hyaluronic acid gel directly into the joint using a thin needle. While some patients may experience mild discomfort during the injection, the procedure is generally well-tolerated.

Knee Viscosupplementation Benefits

There are several options for the non-operative treatment of knee osteoarthritis, including intra-articular knee injections. Corticosteroid knee injections will reduce the inflammation within the joint, improving osteoarthritis pain temporarily. However, once the steroid wears off, the inflammation will eventually recur and the knee pain will return.

Another treatment option given by injection is viscosupplementation. This is an injection of hyaluronic acid – a key component of normal synovial fluid. This injection comes in single-dose or triple-dose versions, and can improve the viscosity of the synovial fluid. This allows the knee to bend more smoothly without any catching or grinding – this is of most benefit in the early stages of arthritis before full thickness cartilage wear has occurred.

Risks

While viscosupplementation is generally safe, it’s essential to consider potential risks and limitations:

Temporary Discomfort: Some patients may experience temporary discomfort, swelling, or warmth at the injection site.

Allergic Reactions: Although rare, allergic reactions to hyaluronic acid can occur. Patients with known allergies should discuss this with their healthcare provider.

Not Suitable for Everyone: Viscosupplementation may not be suitable for individuals with certain medical conditions or advanced knee osteoarthritis.

 

What to Expect After the Procedure

After receiving viscosupplementation, patients are typically advised to avoid strenuous activities for a few days and may be instructed to perform specific exercises to strengthen the knee muscles. While some individuals experience immediate relief, it may take several weeks for the full benefits of the treatment to be realized.

 

Outcomes

Many patients experience excellent pain relief from viscosupplementation injections that often lasts significantly longer than corticosteroid injections. However, not all patients are candidates to receive these injections – if performed in a patient who is not suitable, the results will be disappointing. Your surgeon will be able to tell you if you are a candidate for viscosupplementation injections.

 

Conclusion

Viscosupplementation offers a promising option for individuals seeking relief from knee osteoarthritis. By replenishing the natural lubricant in the knee joint, this minimally invasive procedure can reduce pain, improve function, and enhance overall quality of life. However, it’s essential to consult with a healthcare professional to determine if viscosupplementation is the right treatment option for you. With proper care and guidance, viscosupplementation could be the key to regaining mobility and enjoying life without the burden of knee pain.

Do you have more questions? 

How long does it take for the effects of viscosupplementation to wear off if it doesn’t provide relief?

If viscosupplementation does not provide significant relief from knee osteoarthritis symptoms, the effects typically wear off within a few months after the final injection. Your orthopedic surgeon can discuss alternative treatment options if viscosupplementation is not effective for you.

Can viscosupplementation be used to treat knee pain caused by conditions other than osteoarthritis?

Viscosupplementation is primarily indicated for knee osteoarthritis, but it may also be considered as a treatment option for other conditions that cause knee pain, such as rheumatoid arthritis or traumatic injury. Your orthopedic surgeon can evaluate your specific condition and determine if viscosupplementation is appropriate for you.

How does the cost of viscosupplementation compare to other treatments for knee osteoarthritis?

The cost of viscosupplementation varies depending on factors such as the type of hyaluronic acid used, the number of injections required, and your insurance coverage. While viscosupplementation may have a higher upfront cost compared to corticosteroid injections, some individuals find it to be a cost-effective long-term solution due to its prolonged effects and potential reduction in the need for surgery.

Can viscosupplementation be used as a preventive measure for knee osteoarthritis?

While viscosupplementation is primarily used to treat existing knee osteoarthritis, some research suggests that it may have a role in preventing further cartilage damage and delaying the progression of osteoarthritis. However, more studies are needed to determine its efficacy as a preventive measure.

Are there any alternative treatments to viscosupplementation for knee osteoarthritis?

Yes, alternative treatments for knee osteoarthritis include oral medications, physical therapy, corticosteroid injections, platelet-rich plasma (PRP) therapy, and surgical interventions such as knee replacement. Your orthopedic surgeon can help determine the most appropriate treatment approach based on your individual needs and preferences.

What is viscosupplementation made of?

Viscosupplementation is made of hyaluronic acid and its derivative called Hyalgan.  These are viscous substances which mimic the joint fluid and are very similar to the joint fluid that is present in the body. They are injected to restore the joint fluid and its characteristics so as to allow the joint to move smoothly.

How long do hyaluronic acid fillers last?

Hyaluronic acid fillers usually last more than six months. Some patients do not need to have another shot of hyaluronic acid filler until they are symptomatic again.

What are different types of knee injections?

There are multiple varieties of commercial knee injections, gel injections available in the market which include Hyalgan, Synvisc, Gel-One, Supartz, Orthovisc, Euflexxa, Monovisc.  They differ in their molecular weight but are almost similar in mechanism of action and result. Specific hyaluronic acid injections are usually covered by Medicare.

What is the rooster comb shot?

A rooster comb shot is another name for viscosupplementation as hyaluronic acid is found in high concentration in the comb of the rooster and is traditionally related to it.

What are the side effects of Synvisc?

Side effects of Synvisc include pain, swelling, allergic reaction with the injection.  If the injection is wrongly put into the soft tissue rather than the joint, then it may cause localized swelling and worsening of the pain.

Is hyaluronic acid a steroid?

Hyaluronic acid injections are not steroid injections. Though they have anti-inflammatory characteristics like steroids, they usually do not have the detrimental side effects of steroids. There is minimal systemic absorption and effects.

Why is cortisone shot bad for you?

Cortisone injections if given every three month or more usually do not have much detrimental effects on the joint as well as the body.  If they are given at a more frequent interval, then they may cause side effects. 

At the same time even a single shot of cortisone injection may cause some worsening of pain, swelling and due to its systemic effect, may cause fluctuation in sugar level especially in diabetic patients. If given too frequently, they may have other systemic effects like elevation of blood pressure, osteoporosis, and vitamin D deficiency.

How many times can you get a cortisone shot?

A person can get cortisone shot almost every 3 months until the time that they get decreasing relief, decreasing period of relief with the cortisone injection for less than two to three months.

Who is a good candidate for viscosupplementation injection?

Patients who are allergic or unwilling to get cortisone injections or who are no longer relieved with cortisone injections and have pain due to arthritis are good candidates for viscosupplement injections. Patients with early arthritis are also good candidates for viscosupplementation.

Can viscosupplementation be alternative for people looking to avoid surgery?

Patients who are trying to avoid surgeries due to various reasons can try viscosupplementation to improve their symptoms and avoid or delay the surgery. If these patients are in an advanced disease stage, then these injections may not be helpful.

What happens after a cortisone or a viscosupplementation injection?

After the injection, the patient may have worsening of pain and swelling in the knee for the next two to three days. They are advised to use anti inflammatory medication along with elevation and ice to decrease the worsening of the symptoms. After about two to three days, the injection starts providing pain relief which may take up to a week and give good pain relief.

Can steroid shots make you gain weight?

Single steroid shot usually does not have much systemic resorption to cause systemic effects like weight gain, but if cortisone shots are given too frequently, then they may cause weight gain.

Can you take ibuprofen after getting a cortisone shot?

Patients are advised to take anti-inflammatory medications like Aleve or Advil if they can tolerate after the cortisone injection to avoid worsening and decrease the pain and swelling due to the disease as there is a cortisone injection.

What type of doctors give the cortisone shot?

Cortisone shot can be given by a primary care physician or a sports physician or an orthopedic surgeon, rheumatologist, as well as Sports Medicine physician.

What are the experiences of stem cell or PRP injections for joint regeneration?

PRP injection is more commonly used nowadays clinically and have shown promising results lasting a few months. If the patient is unwilling to take cortisone injection or is allergic to cortisone, they can have PRP injections for pain relief.

Can a cortisone shot help a torn meniscus?

A cortisone shot in a scenario of torn meniscus can help decrease pain and swelling.  It though will not cause healing of the meniscus.  At the same time, if a meniscal repair surgery is being contemplated in the near future, then the patient should avoid taking cortisone injection as it may impair healing of the meniscus.

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

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