Knee Viscosupplementation

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.