Viscosupplementation for Knee Arthritis

Hyaluronan injections are a treatment option for osteoarthritis of the knee. In osteoarthritis, as cartilage wears away, synovial fluid changes and loses its ability to lubricate the joint. Pain, stiffness, and limited range of motion for the affected joint are the result of the deterioration. The treatment which injects hyaluronan into the knee, known as viscosupplementation, is an effort to improve the lubrication of the knee, reduce pain, and improve range of motion. Here are some things you should know about hyaluronan injections.
Hyaluronan is usually not a first line treatment for knee osteoarthritis.
Typically, hyaluronan injections (also sometimes called viscosupplements) are recommended for patients who have not found adequate pain relief from more conservative treatment options:
• Medications
• Exercise / Physical Therapy
• Weight loss if patient is overweight
• Heat and cold
• Assistive mobility devices (e.g., cane)
Although, hyaluronan injections are not usually recommended before trying other treatment options, the best result usually occurs if the patient is in the early stages of osteoarthritis. Patients in the later stages of osteoarthritis, who may be waiting for knee replacement surgery, are considered good candidates for hyaluronan injections so they hopefully can get some relief while waiting.
How well hyaluronan injections work has been debated.
Clinical studies have concluded that hyaluronan injections can decrease pain and improve function in patients with mild to moderate osteoarthritis of the knee. There is no evidence that suggests hyaluronan injections affect the underlying disease course. It is clear that the injections are not a cure.
Among patients who were helped by hyaluronan injections, when pain relief occurred was variable.
The most significant pain relief occurred 8 to 12 weeks after the first injection for most patients. Studies have shown that Synvisc and Hyalgan provide pain relief from knee osteoarthritis for up to six months, with some patients getting relief for an even longer duration. Patients may be able to repeat the course of treatment with hyaluronan injections. For example, a patient who has experienced up to six months of pain relief from Synvisc but has had pain return may be a candidate for another course of Synvisc injections.
To minimize potential side effects, after an injection patients should avoid strenuous activities for 48 hours.
The most common side effects around the injected joint, which are usually mild, include:
• temporary injection site pain
• swelling
• redness and warmth
• itching
• bruising
The patient does not have to stop other medications they are taking when getting hyaluronan injections.
There should be no adverse interaction with other pain medications or anti-inflammatory medications that a patient is taking.
Dr. Harinder Batth
Orthopedic & Joint Replacement Surgeon