Viscosupplementation

Here at Direct Orthopedic Care (DOC), many patients come to us to in an attempt to avoid surgical interventions. One of the common treatments our providers will suggest before recommending surgery is viscosupplementation. Many of our patients have never heard of this treatment before having an injection at one of our four locations in the Boise area.

What is viscosupplementation?

Viscosupplementation, often referred to chicken shots or hyaluronate injections, is used to treat knee osteoarthritis. This gel-like substance is injected into the knee joint, the idea being to mimic the function of the synovial fluid in the knee. When a knee is affected with osteoarthritis, the cartilage is damaged and the synovial fluid cannot lubricate the joint. Viscosupplementation injections contain hyaluronic acid, which occurs naturally in synovial fluid. This substance to helps lubricate and reduce friction in the joint.

These injections were first approved for use by the United States Food and Drug Administration (FDA) in 1997. They are used after other conservative treatment options have been unsuccessful (e.g., physical therapy, heat and ice applications, anti-inflammatories, or the use of steroid injections such as Kenalog). There are multiple manufacturers for these hyaluronic acid treatments. Hyalgan was one of the first injections to be approved in 1997, which consists of a series of 5 injections. Euflexxa involves a series of 3 injections, and it received FDA approval in 2004. One of the newest treatments is a 1-injection procedure, Gel-One, which was approved in 2011.

Will it help my knee pain?

Patients who report success with these injections generally experience the greatest level of pain relief between two and three months. Most insurance companies allow patients to repeat these injections after six months. Additionally, some insurance companies prefer patients to try a 3 or 5 series before trying a single dose such as Gel-One.

However, as with any course of treatment, viscosupplementation injections do not yield positive outcomes for everyone. Empirical research indicates that injections tend to be most successful when patients are in the early stages of osteoarthritis. Patients who have advanced osteoarthritis may benefit from considering other options, such as a knee replacement, for relief.

Patients often expect mild pain, along with an uncomfortable feeling, after the fluid is injected into the joint. Some patients experience pain at the injection site, swelling, redness, heat, rash, itching, bruising, or fluid in the joint. Other, less prevalent side-effects include infection, bleeding, or even allergic reactions.

If you suffer from osteoarthritis and would like to learn more about viscosupplementation, visit DOC any day of the week.

Sources:

Viscosupplementation Treatment for Knee Arthritis. OrthoInfo. American Academy of Orthopaedic Surgeons (AAOS). June 2015.
http://orthoinfo.aaos.org/topic.cfm?topic=a00217