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Viscosupplementation

(Hyaluronic Acid Injection; Injection, Hyaluronic Acid)

Definition

Viscosupplementation is an injection of a fluid called hyaluronic acid into the knee joint.

Reasons for Procedure

This injection is used to treat the symptoms of osteoarthritis (OA).
Joints Affected by Osteoarthritis
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Healthy joints contain synovial fluid. This fluid lubricates and provides nutrients to the joints. One change that happens with OA is the synovial fluid becomes thinner and less useful as a lubricant for the joint.
With viscosupplementation, hyaluronic acid, which is found in synovial fluid, is injected into the knee joint. This makes the synovial fluid act as a better lubricant. It is hoped that this will reduce pain and improve function of the joint. In some cases, getting this injection may help to postpone surgery on the knee joint.
Viscosupplementation may be a good option if you have tried other types of treatment (eg, medicines, physical therapy) and these have failed.

Possible Complications

Complications are rare. But, no procedure is completely free of risk. If you are planning to have viscosupplementation, your doctor will review a list of possible complications, which may include:
  • Pain and swelling
  • Infection at the injection site
  • Bleeding
  • Allergic reaction to the hyaluronic acid or local anesthetic product
  • Gout
  • Inflammation of the blood vessels (vasculitis)
These factors reduce the chance that viscosupplementation will be effective for you:
  • Having advanced OA
  • Being 65 years or older
Talk to your doctor about these risks before the procedure.

What to Expect

Prior to Procedure

Before getting this injection, your doctor will most likely have you try many other ways to treat OA, such as:
  • Taking pain medicines
  • Getting injections of corticosteroids
  • Doing physical therapy
  • Losing weight
If these methods are not helpful, then viscosupplementation may be a good option for you. Before the injection, your doctor may:
  • Have x-rays done to determine the severity of your OA
  • Ask you if you have any allergies (eg, chicken allergy) to the ingredients in the hyaluronic acid product
If you are taking any prescription medicines, over-the-counter products, or herbs and supplements, talk to your doctor. There could be an interaction with the injection.

Description of the Procedure

First, your doctor will clean the skin where the needle will be inserted. A local anesthetic may be applied to numb the area. If you have swelling in the knee joint, the doctor will use a needle to remove the excess fluid. Next, a needle will be used to inject the hyaluronic acid into the joint. If needed, both knees can be done at the same appointment.
While your schedule for receiving injections will vary depending on the brand, you may have a cycle of three injections (eg, on days 1, 8, and 15) or just one. You may need to go through injections more than once. In some cases, it can relieve pain for months to years.

How Long Will It Take?

The procedure usually takes a few minutes to do.

Will It Hurt?

You may feel the prick of the needle. Right after the injection, you may have some mild pain, warmth, and swelling around the knee joint.

Post-procedure Care

At Home
When you return home after the procedure, do the following to help ensure a smooth recovery:
  • To reduce pain and swelling, apply an ice pack. You may want to do this for 15-20 minutes, four times a day. Wrap the ice in a towel. Do not apply it directly to your skin.
  • For the first two days, avoid straining your knee. Do not stand for a long time or do strenuous activity, like heavy lifting.
As you go through the injection cycles, you may have:
  • Less knee pain
  • Improved mobility

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, bleeding, or discharge from the injection site
  • Signs of allergic reaction (eg, hives , itching, difficulty breathing)
  • Increased pain or swelling in the knee joint

RESOURCES

American College of Rheumatology http://www.rheumatology.org/

The Arthritis Foundation http://www.arthritis.org/

CANADIAN RESOURCES

The Arthritis Society http://www.arthritis.ca/

Canadian Arthritis Network http://www.arthritisnetwork.ca/

References

Arnold W, Fullerton D, Holder S, May C. Viscosupplementation: managed care issues for osteoarthritis of the knee. Academy of Managed Care Pharmacy website. Available at: http://www.amcp.org/data/jmcp/May07%5Fsuppl.pdf. Published May 2007. Accessed February 23, 2011.

Condon G. Putting a needle where it hurts. University of Connecticut Health Center website. Available at: http://today.uchc.edu/headlines/2005/may05/knees.html. Published May 17, 2005. Accessed February 23, 2011.

Divine JG, Zazulak BT, Hewett TE. Viscosupplementation for knee osteoarthritis: a systematic review. Clin Orthop Relat Res. 2007;455:113-122.

DynaMed Editorial Team. Degenerative joint disease of the knee. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 15, 2011. Accessed February 23, 2011.

Editorial staff and contributors. Osteoarthritis. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary. Updated September 2010. Accessed February 23, 2011.

Joint aspiration. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/joint%5Faspiration%5Finjection/hic%5Fjoint%5Faspiration%5Fand%5Finjection.aspx. Accessed February 24, 2011.

Jordan J. Comparison of four treatments for patients with severe knee cartilage damage. University of Wisconsin-Madison website. Available at: http://tc.engr.wisc.edu/uer/uer01/author1/content.html. Published June 17, 2011. Accessed February 23, 2011.

Viscosupplementation treatment for arthritis. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00217. Updated February 2009. Accessed February 23, 2011.

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