Viscosupplementation refers to the injection of a hyaluronan preparation into the joint. Hyaluronan is a natural substance present in the joint fluid that assists in lubrication. It allows smooth movement of the cartilage covered articulating surfaces of the joint.
Viscosupplementation is indicated in the management of shoulder, knee, hip or ankle osteoarthritis that has not responded to non-surgical treatment options such as pain medications, physical therapy and corticosteroid injections.
Viscosupplementation provides symptomatic relief and delays the need for surgery. It is injected directly into the joint to replenish the diminished synovial fluid, thereby enhancing its lubricating properties. A single dose or a total of three separate doses of Viscosupplement, over several weeks, may be required for optimum benefit.
Some patients may experience mild pain, swelling, warmth and redness at the injection site for up to 48 hours following a Viscosupplement injection. Headache and joint stiffness may also occur in some cases. Ice packs and an analgesic may be used, if required, to ease the discomfort. Any strenuous activity such as jogging or tennis should be completely avoided for 48 hours to a week after the injection and should be resumed only after consultation with your doctor.
Viscosupplement injection not only supplements the hyaluronan in the joint but also stimulates the production of hyaluronan in the treated knee. This provides gradual symptomatic relief over the course of the injections. This effect may last for several months.
Please note: Immediately consult your doctor if you develop fever or the pain and swelling fail to resolve after 48 hours following the injection.
Not all patients get good pain relief viscosupplementation. It has been found that viscosupplementation is most effective if the arthritis is in its early stages (mild to moderate). For those who report pain relief with the procedure, it may take several weeks to notice an improvement. Pain relief may last up to several months following the injections. If the injections are effective they may be repeated after a period of time, usually 6 months. Viscosupplementation has never been shown to reverse the arthritic process or re-grow cartilage.
Viscosupplement comes under various brand names like Synvisc, Orthovisc, Monovisc, Supartz, Euflexxa, Hyalgan etc.
How Effective Is Viscosupplementation?
Clinical studies have demonstrated the efficacy of viscosupplementation in reducing pain and improving function. According to research reviewed by Peck et al., viscosupplementation offers relief comparable to or better than NSAIDs and corticosteroids, with longer-lasting effects. While the effectiveness can vary from patient to patient, many report feeling significant improvements within weeks of receiving the injections.
However, some studies have indicated that certain factors, such as age and the severity of osteoarthritis, may influence the effectiveness of the treatment. Patients with advanced OA may find less relief from viscosupplementation compared to those in earlier stages of the disease.
Is Viscosupplementation Covered by Insurance?
Viscosupplementation is considered a medical treatment for osteoarthritis and may be covered by health insurance, including Medicare. Coverage varies depending on your insurance plan, so it is essential to check with your provider before beginning treatment.
Alternatives to Viscosupplementation
While viscosupplementation is an excellent option for many patients, it is not the only non-surgical treatment available for knee OA. Other alternatives include:
- Physical Therapy: Strengthening the muscles around the knee joint can improve stability and reduce pain.
- Corticosteroid Injections: These injections provide rapid relief from inflammation and pain, though the effects are generally short-term compared to viscosupplementation.
- Platelet-Rich Plasma (PRP): This newer treatment involves injecting concentrated platelets from your blood into the knee to promote healing and reduce inflammation.
- Surgical Options: If conservative treatments fail, partial or total knee replacement surgery may be necessary to restore function and alleviate pain.
Conclusion
Viscosupplementation is a promising treatment option for patients with knee osteoarthritis who are looking for non-surgical solutions to manage their symptoms. It offers the potential for pain relief, improved mobility, and delayed knee replacement surgery. By consulting with your healthcare provider, you can determine whether this treatment is right for you and begin taking steps toward a more active, pain-free lifestyle.
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 are the potential complications of viscosupplementation?
While complications are rare, potential risks of viscosupplementation include infection, bleeding, allergic reactions, and damage to surrounding tissues. These risks can be minimized by ensuring proper injection technique, using sterile conditions, and carefully selecting suitable candidates for treatment.
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.
