What Is Viscosupplementation?

Viscosupplementation injections, or hyaluronic acid (HA), are a minimally invasive treatment for osteoarthritis (OA), primarily in the knee. This treatment aims to restore the viscoelastic properties of synovial fluid, which are compromised in OA, thereby improving joint lubrication and shock absorption.

The procedure involves injecting hyaluronic acid—a naturally occurring substance in joint fluid—directly into the affected joint. This helps restore cushioning, improve mobility, and reduce pain.

How Do Viscosupplementation Injections Work?

Hyaluronic acid acts as a lubricant and shock absorber for your joints. In people with OA, the natural hyaluronic acid in the joint breaks down, leading to increased friction and pain. By injecting this gel-like substance into the knee, viscosupplementation helps:

✔️ Restore lost lubrication ✔️ Reduce inflammation ✔️ Improve joint movement ✔️ Delay the need for surgery

Different HA products vary in molecular weight and formulation, which may influence their efficacy and duration of action. High molecular weight HA, such as hylan G-F 20, has been shown to provide longer-lasting relief compared to lower molecular weight formulations, although the cost is higher [Adams et al, 2000]. Despite these differences, no single product has been definitively proven superior in head-to-head comparisons [Hunter et al, 2022].

Who Is a Good Candidate for Viscosupplementation?

If you have mild to moderate osteoarthritis and haven’t found relief from physical therapy, over-the-counter pain medications, or lifestyle changes, viscosupplementation may be worth considering. It is especially beneficial for individuals who:

• Experience chronic knee pain
• Have difficulty walking or exercising due to joint discomfort
• Want to delay or avoid knee replacement surgery
• Have not responded well to corticosteroid injections

However, those with severe osteoarthritis or significant joint deformity may not benefit as much from this treatment.

What to Expect During the Procedure

The process is simple and typically takes just a few minutes in your doctor’s office:

1. Preparation: The knee is cleaned, and sometimes excess fluid is drained before the injection.
   
2. Injection: The hyaluronic acid is carefully injected into the joint space using a fine needle.
   
3. Post-Treatment Care: You may be advised to avoid strenuous activity for 24-48 hours.

Most patients notice gradual improvement over several weeks, with pain relief lasting up to six months or longer.

Are There Any Side Effects?

Viscosupplementation is generally well-tolerated, but some patients may experience temporary side effects such as:

• Mild swelling or stiffness at the injection site
• Temporary pain or discomfort
• A small risk of infection (rare)

If you have any concerns, your doctor will discuss ways to minimize risks.

Viscosupplementation vs. Other Treatments

The American Society of Pain and Neuroscience (ASPN) provides guidelines on the use of HA injections for knee pain. These guidelines highlight that HA can stimulate cartilage synthesis and reduce inflammation, offering a potential benefit over oral NSAIDs, particularly in the elderly population due to a better long-term side effect profile [Hunter et al, 2022].

How does viscosupplementation compare to other osteoarthritis treatments?

What is the Evidence for Viscosupplementation Injections?

Clinical evidence on the efficacy of HA injections is mixed.

• A meta-analysis published in JAMA reviewed 22 trials and found a small but noticeable effect of HA injections compared to placebo [Lo et al, 2003].
  
• Another systematic review indicated that HA injections provided statistically significant pain relief compared to oral NSAIDs [Pereira et al, 2022].
  

How to Get Started with Viscosupplementation

If knee pain is interfering with your daily life, it’s time to explore your options. Contact us below to help determine if viscosupplementation is right for you.

(781) 591-7855

info@BSBortho.com

20 Walnut St

Suite 14

Wellesley MA 02481

References:

1. Adams ME, Lussier AJ, Peyron JG. A risk-benefit assessment of injections of hyaluronan and its derivatives in the treatment of osteoarthritis of the knee. Drug Saf. 2000 Aug;23(2):115-30.
   
2. Hunter CW, Deer TR, Jones MR, Chang Chien GC, D'Souza RS, Davis T, Eldon ER, Esposito MF, Goree JH, Hewan-Lowe L, Maloney JA, Mazzola AJ, Michels JS, Layno-Moses A, Patel S, Tari J, Weisbein JS, Goulding KA, Chhabra A, Hassebrock J, Wie C, Beall D, Sayed D, Strand N. Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience. J Pain Res. 2022 Sep 8;15:2683-2745.
3. Lo GH, LaValley M, McAlindon T, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA. 2003 Dec 17;290(23):3115-21.
   
4. Pereira TV, Jüni P, Saadat P, Xing D, Yao L, Bobos P, Agarwal A, Hincapié CA, da Costa BR. Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis. BMJ. 2022 Jul 6;378:e069722.