The number of people not satisfied with giving up their activities because of knee pain is growing. My patients tell me that 50 is the new 30. As a result, options for treatment of osteoarthritis have become increasingly important. We have been reviewing the simpler treatment options for osteoarthritis over the past few episodes. Injection options are primarily steroid injections and hyaluronic acid injections. I’ll save steroid injections for another article.
These injections are among the treatments we have for osteoarthritis with proven benefits. Many patients want to try everything possible before having surgery, and this is a great option ! If it works, you can always repeat the injection series months later.
Viscosupplementation is a long term to describe the injection of hyaluronic acid into the knee. This compound is a naturally occurring component of joint fluid and cartilage. It is not a drug. It was originally derived from rooster’s combs, of all things ! It is usually given as a series of injections over a series of weeks (typically either 3 or 5 weeks), one a week. It is a quick injection that takes 2-3 seconds to give.
There are about 6 major brands of hyaluronic acid, all with slight twists on the formulation, as well as different dosing regimens from a single shot to 5 shots over 5 weeks. My practice success seems highest with the multi-injection routine. There are product brochures on my website. Click here to download / read these.
I studied a large group of patients who received these injections and followed them for 6 months afterward. In my series, about 50-60% of patients felt better after 5 injections. Most major research studies show similar results, often mixed in terms of success. Some physicians build their entire practice around these injections, and refer out when they are not effective.
Many of my San Diego patients tell me about an ‘article’ they see in the paper each week (actually an ad) showing how few doctors know about this treatment and can do it properly-be careful what your read !
There are no significant side effects from these injections unless you are allergic to eggs or have gout. Soreness after the injections for a few hours is not surprising. In my office we often use ultrasound to localize the injection and confirm needle placement in the joint where we want it to go.
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The goal of these injections is to REDUCE pain. They do NOT grow new cartilage. Patients typically feel better for up to 6 months. It may take up to a few weeks after all of the injections before you will see improvement.
Platelet rich plasma is an exciting new option that seems to show promise for osteoarthritis. Learn more here.
Overall, viscosupplementation is another FDA approved nonoperative treatment for osteoarthritis. It’s hard to know if it will work for you and how long it will last, but something many patients will consider before thinking about more aggressive and longer lasting treatments.