FAQs on Visco-Supplementation

 

Viscosupplementation is the term for addition a lubricating, gel-like fluid into the joint to replace lost synovial fluid. The doctor uses hyaluronic acid to replace the fluid lost from the joint due to arthritis, wear-and-tear, and age.

What is hyaluronic acid?

Hyaluronic acid occurs naturally in the body and the synovial fluid. It serves as a cushion to protect joints from impact and the load. In addition, it is a lubricating agent that allows the bones to move smoothly across one another. With viscosupplementation, hyaluronic acid is added back into the joint to reduce pain, improve movement, and cushion the joint.

Who benefits from viscosupplementation?

Viscosupplementation is used for treatment of osteoarthritis of the knee, but it is sometimes used for other joints. The benefits of this procedure are:

  • Decreases pain
  • Improves walking, standing, and movement
  • Delays surgery
  • Improves overall quality of life

How do I prepare for the viscosupplementation procedure?

When you agree to have viscosupplementation, the doctor reviews the procedure risks and benefits and has you sign a consent form. The doctor will also ask you questions about your medications, as certain ones thin the blood and must be held for a few days. The doctor may want to take additional imaging tests, to assess your joint status.

How is the viscosupplementation done?

The doctor will have you put on a gown so he can access your joint. The skin is first cleaned with an antiseptic. The skin may be numbed using an anesthetic, and then the procedure needle is guided into the space under real-time x-ray. Once position is verified, the hyaluronic acid is injected. After the needle is removed, the area is covered with a band-aid.

Will I have restrictions after the viscosupplementation procedure?

After your knee injection with hyaluronic acid, you should rest for the remainder of the day. Your knee will be slightly tender at the injection site. Avoid anti-inflammatory drugs. The joint may feel better immediately, but results are often not felt for 1-2 days. Avoid strenuous activities, and gradually return to usual duties.

How often is viscosupplementation done?

The U.S. Food and Drug Administration approved viscosupplements in 1997. The frequency of the injection depends on the type of product. Options are:

  • Euflexxa (sodium hyaluronate) – This brand is given as a 3-dose series over three weeks. You come to the office once a week for an injection, and the series lasts for around 6 months.
  • Hyalgan (sodium hyaluronate) – This is given in a series as well, once a week for 5 weeks.
  • Orthovisc (high-molecular-weight hyaluronan) – This agent is a 3- or 4- dose series that is given weekly.
  • Supartz (sodium hyaluronate) – Another weekly injection that is given in a 3-dose series. Supartz offers 3-6 months of pain relief.
  • Synvisc-One (hylan G-F 20) – This product is a one-dose injection that can be given every 6 months.
  • Synvisc (hylan G-F 20) – This product is given in a 3-dose weekly shot series and lasts for up to 6 months.

How effective is viscosupplementation?

Pain relief lasts from 3 to 6 months, with some patients having improvement for up to a year. It may take a few weeks to notice improvement in the joint. The maximum benefits are observed around 5 weeks’ post-injection. Clinical studies have shown that viscosupplementation is beneficial for people with arthritis. In a recent randomized controlled trial, 71% of patients were symptom-free at 26 weeks, which was much better than those who received NSAIDs therapy or placebo.

Resources

Wen DY (2000). Intraarticular Hyaluronic Acid Injections for Knee Osteoarthritis. Am Fam Phys, 62(3), 565-570.