Viscosupplementation With Hyaluronic Acid Injections for Knee Arthritis

In the world of knee injections, there are your typical steroid injections and then there are injections that are non-steroidal. One of these is termed viscosupplementation and consist of hyaluronic acid. The hope is to provide lubrication to the joint and also stimulate the joint to produce more lubricating synovial fluid in a nonoperative fashion with a low risk profile.

There are no better substances that have come onto the market which perform this function currently. There are some regenerative substances that have come into existence including stem cells that have shown some promise, but nothing that has been the subject of long term randomized prospective studies yet.

It is an injection of a gel like medication into the knee joint to supplement or replace the thick synovial fluid that cushions the joint. This treatment may help reduce arthritis pain. The doctor sterilizes the skin and then numbs up the area of injection.

The physician will then place a needle carefully into the knee joint space. At that point, the hyaluronic acid preparation is injected, which will then cushion the joint. A small bandage is applied after the knee injection is completed. Pain relief may occur right away, or it may take weeks.

The hyaluronic acid preparations come in numerous formulations and are named Synvisc, Hyalgan, etc. Synvisc is made up of salt water, and sodium hyaluronate. The hyaluronic acid part actually comes from the combs of chickens. When injected, there is no graft versus host true reaction.

The injections may be placed either in one injection or a series of injections. It used to be they all required multiple injections, but there is a new formula that provides the medication in a "long lasting" preparation.

It is very important that the doctor sterilizes the area diligently. One of the complications that can be seen with these injections is a pseudo infection where the area gets red, itchy, and painful. This typically goes away within a few days without antibiotics since it is not really an infection.

How well do they work? A number of studies have been completed, with the overall results showing over a 60% good to excellent results at one year. In younger patients who still have some cartilage remaining, the main goal is to reduce pain while eliminating the need for a joint replacement. We know that joint replacements work great, but are not able to last over 10 to 20 years.