Viscosupplementation – The Basics
Viscosupplementation, or visco, is an injection that can be used to help with the symptoms of knee osteoarthritis. It is a thick, gel like substance made up of hyaluran, or hyaluronic acid. Some people have compared the injection of visco with putting motor oil in an engine due to it’s thick, viscous nature. It provides lubrication to the joint and also delivers a biologically important substance to the knee cartilage. It is sometimes performed as a series of injections, and sometimes performed as a single injection.
Osteoarthritis & Disability
Osteoarthritis of the knee is the leading cause of disability in the United States. While there is no cure for it arthritis, there are many treatment options available to help restore knee function and improve knee pain. Osteoarthritis is a pain that develops slowly over time, causing symptoms such as inflammation, tenderness, and stiffness.
Conservative Management of Osteoarthritis
In the early stages, arthritis of the knee is treated with conservative treatment. The following options are effective ways to improve symptoms and help control knee pain.
- Low impact activities such as elliptical, bicycle, and aquatic therapy
- Anti-inflammatory foods for knee arthritis, medications such as acetaminophen
- Maintaining a healthy body-weight
- Good quality, cushioned shoes
- Physical therapy to increase knee range of motion and strengthen the muscles around the knee and hip
- Compressive knee sleeve to help limit swelling and provide proprioceptive feedback
- Pain relievers such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and naproxen
- Corticosteroid injections
- Over the counter solutions such as glucosamine and chondroitin
If you have tried other nonsurgical treatment options and your pain continues to limit your activities, another treatment option is a procedure called viscosupplementation. This can be a viable treatment for mild to moderate knee osteoarthritis that did not respond adequately to conservative treatment such as therapy and simple analgesics.
Viscosupplementation for osteoarthritis of the knee is a therapeutic injection of gel-like fluid called hyaluronic acid, which is injected into the knee joint by a healthcare professional, such as an orthopedic surgeon. This intra-articular injection is one of the few “biologic” treatments that is covered by commercial insurance and Medicare.
Hyaluronic acid is a naturally occurring substance found in the synovial joint fluid, which acts as a lubricant in the synovial fluid to enable bones to move smoothly over each other. It also helps to act as a shock absorber for joint loads. One form in which it is found is sodium hyaluronate.
People with osteoarthritis have a lower-than normal concentration of hyaluronic acid in their joints. Viscosupplementation for osteoarthritis of the knee adds hyaluronic acid to the arthritic joint to facilitate movement and reduce pain, acting as the naturally occurring joint fluid.
Recent research shows that 70-80% of people with mild to moderate osteoarthritis will have noticeable improvement with pain. However, even if you do not have improvement in pain symptoms, the injections may help improve the health of your knee cartilage. Viscosupplmentation is not just for the treatment of pain or pain relief.
Viscosupplementation was first used in Europe and Asia, and was approved by the U.S Food and Drug Administration in 1997. Several preprations of hyaluronic acid are now commercially available, which include: Hyalgan, Supartz, Synvisc, Euflexxa, Gelsyn, Injection Euflexxa, and hylan g f20, Orthovisc, supartz fx.
Viscosupplementation used to be obtained from a “rooster’s comb,” also known as rooster comb injections, but newer versions are created in a lab. Examples of currently available options include euflexxa injection (uflexa, eflexa, euflexa), synvisc injection, gelsyn injection, orthovisc injection, supartz injection. Prescribing information available from the manufacturer. This blog post doesn’t serve as medical advice. Please seek treatment information from your prescribing provider. It is generally indicated for patients with mild to moderate knee OA who failed to respond adequately to other treatments and patients having knee joint pain.
Partially referenced from Orthoinfo:
How long do viscosupplementation injections last?
Research shows that the beneficial effects of viscosupplementation last approximately 6-12 months.
What are side effects of viscosupplementation?
Side effects of viscosupplementation are uncommon. Viscosupplementation side effects can include soreness at the injection site. Less common side effects would include infection, allergic reaction, and bleeding. Some patients can have a pseudoseptic reaction to the injection which causes redness and swelling in the joint. This is more common with the avian-based products. Newer versions that lack the avian proteins are less likely to cause this.
How effective is viscosupplementation?
Viscosupplementation has shown improvement for the symptoms of knee arthritis (pain, stiffness, swelling) across multiple studies. It appears that 70-80% of patients have a clinically meaningful improvement in their pain level. The effectiveness seems to improve with subsequent series of injections.Some studies have suggested that receiving regular injections of viscosupplementation can help delay the need for knee replacement. That data is mixed an further trials are ongoing. Treatment effects seem to be most effective in patients with mild to moderate osteoarthritis of the knee.
What is viscosupplementation injection?
Viscosupplementation is a treatment for mild to moderate knee osteoarthritis. The main ingredient is hyaluronic acid, a substance that is present in healthy cartilage but lacking in arthritis. These injections are performed on an outpatient basis and are indicated in patients who continue to have knee pain and knee symptoms from knee arthritis despite other conservative therapies (exercise, weight loss, NSAIDs, Tylenol, physical therapy, etc)