As people age, they frequently develop osteoarthritis in one or more joints. Osteoarthritis is a degenerative disease in which the cartilage in the joint wears away, and the synovial fluid surrounding the joint is less effective in lubricating the joint. This increases the likelihood that the bones in the joint rub together when moved, resulting in inflammation, pain, stiffness and limited joint mobility.

Osteoarthritis frequently occurs in the knee. In fact, knee arthritis is one of the most common causes of disability in the United States. Conservative treatments include weight loss, activity modification, pain medications, physical therapy and corticosteroid injections. But when those treatments fail to provide enough relief, doctors may recommend viscosupplementation.

Approved by the U.S. Food and Drug Administration in 1997, viscosupplementation is a minimally invasive procedure in which a health care provider injects hyaluronic acid into the joint. Hyaluronic acid is a naturally occurring material normally found in the synovial fluid, but its concentration is reduced in people with osteoarthritis.

Viscosupplementation seeks to replenish the ability of the synovial fluid to lubricate the joint, making joint movement easier and less painful. This treatment isn’t a cure for osteoarthritis, but it may help alleviate symptoms for a period of time.

How Does Viscosupplementation Work?

Doctors perform viscosupplementation on an outpatient basis.

  • The provider cleans the injection site.
  • They anesthetize the injection site using either a topical or injected numbing agent.
  • If excess fluid is present in the joint, the provider may remove some fluid before proceeding with the injection.
  • The provider injects the hyaluronic acid into the joint using a needle attached to a syringe. They may use imaging, such as ultrasound or X-rays, to help ensure the hyaluronic acid is injected into the correct space.
  • The provider covers the injection site with a bandage.

Are you a good candidate for Viscosupplementation?

  • Positive

    You have knee pain caused by osteoarthritis.

  • Positive

    You have not seen success from other non-surgical treatments.

  • Negative

    You have a more advanced form of osteoarthritis.

  • Negative

    You have an infection or skin disease near the injection site.

  • Negative

    You have edema of the bone.

Frequently asked questions

How Do You Prepare for Viscosupplementation?

Because viscosupplementation is a minimally invasive procedure, people don’t typically have any special dietary restrictions beforehand. They can eat and drink normally and take their regular medications unless the provider tells them not to do so. They should let their provider know about any medications, vitamins or other supplements they take. It’s best to wear loose clothing that permits easy access to the joint undergoing treatment. If the person has an active infection, they should let the provider know. In that case, delaying the viscosupplementation may be advisable.


How Effective Is Viscosupplementation?

Although not everyone who undergoes viscosupplementation experiences relief from osteoarthritis symptoms, many people notice reduced pain within five to 13 weeks of treatment. One study indicates that 62% of those undergoing viscosupplementation enjoyed significant pain relief within four weeks following the procedure, and 71% had reduced pain after eight weeks.

Research suggests the effects of viscosupplementation may last from six months to two years. This procedure offers better pain relief than acetaminophen and may help people delay surgical intervention. Studies have shown an increase in cartilage quality and volume and a reduced loss of joint space within a year following viscosupplementation.

People in the initial stages of osteoarthritis are most likely to benefit from viscosupplementation, especially those who are fairly active and have mild to moderate symptoms. Because precise placement of the injection is critical when it comes to successful outcomes, it’s best to choose a provider who has plenty of experience performing viscosupplementation.


How Long Does Viscosupplementation Take?

Viscosupplementation is an outpatient procedure, and a health care provider may perform it during a person’s office visit. It takes 20 to 60 minutes.

Depending on the person’s needs, only one injection may be necessary. In other cases, though, another one to four shots may need to be administered, spread out over the course of several weeks.


What Are Potential Side Effects of Viscosupplementation?

The majority of people don’t experience any side effects from viscosupplementation. If side effects occur, they’re normally few and mild, and they usually only last for a few hours or days. The most common side effect people experience following viscosupplementation is a flare-up of arthritis pain and swelling immediately following the injection.

Some people also notice swelling, pain and warmth at the site of the injection. Applying ice and taking over-the-counter pain medication may alleviate these symptoms.

Rare side effects include infection and bleeding. If the injection site fills with fluid and becomes red, warm and painful, the person should contact their health care provider.


What Is Recovery after Viscosupplementation Like?

People can normally go home shortly after the viscosupplementation procedure, and some may even be able to go back to work later in the day. However, people recovering from viscosupplementation need to take care when using the treated knee. It’s best to limit weight-bearing activities for 48 hours. People should avoid standing for long time periods, and they shouldn’t run, jog, dance, jump or engage in high-impact aerobics. They should also avoid lifting heavy objects after a viscosupplementation procedure.

Typically, people return to their health care providers periodically to evaluate the results of viscosupplementation and to discuss the next steps. If the initial injection failed to produce desired results, the provider may recommend additional viscosupplementation procedures. If the initial regimen alleviates symptoms, but the pain returns later, viscosupplementation may be repeated.

If viscosupplementation isn’t successful in alleviating pain or the effects wear off after a period of time, the health care provider may then suggest surgical intervention, such as a knee replacement.

Northeast Spine and Sports Medicine has a team of specialists that includes surgeons, cardiologists, massage therapists and occupational therapists who can collaborate to diagnose and treat pain. Contact them to schedule an appointment for an evaluation and to discuss a treatment plan.


What Is Viscosupplementation Used For?

Health care providers typically recommend viscosupplementation to alleviate pain and stiffness related to osteoarthritis in the knee. It’s not the first treatment health care providers recommend, however. Before suggesting viscosupplementation, health care providers usually prescribe more conservative treatments. When those fail to provide desired results, viscosupplementation may be the next step.

While this procedure is typically used to treat knee pain, research suggests viscosupplementation may be useful in the treatment of shoulder, hip and wrist pain.


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