Say those words again? Viscosupplementation…hyaluronic acid? Those words do not roll off the tongue very easily! Thankfully, the use of this medication is easier than trying to pronounce it. You may have heard friends or family refer to “chicken shots” when treating knee arthritis. These are the same thing. The original formulations were derived from rooster combs, hence the nickname “chicken shots”. There are still a few brands that use this as the basis for the injections, however there are a variety of brands on the market today that are synthetically produced.

So, why do we use viscosupplementation injections? First, let’s briefly describe what arthritis is exactly. Arthritis is an inflammatory process where a joint is essentially wearing out. Refer to the two pictures below for a visual understanding. When a joint develops arthritis, the articular cartilage on the joint surface becomes thinner and wears away. With the knee, the menisci can also wear out, become thin and tear. As a result, osteophytes (bone spurs) can form, and the joint space can narrow. All joints have fluid (synovial fluid), that helps lubricate the bones that rub on each other and act as a shock absorber. With arthritis, there is a reduced concentration of hyaluronic acid, resulting in the joint fluid becoming less viscous (becoming thinner). Thinner joint fluid can result in a joint that is not as mobile and be more painful with motion and activity.

Viscosupplementation injections are a minimally invasive treatment option available in our toolbox in treating knee arthritis and delaying the possible need for a total joint arthroplasty. These treatments have been approved by the FDA in the United States for over 25 years. The purpose of these treatments is to increase the concentration of hyaluronic acid, therefore improving lubrication to the knee cartilage. You can imagine that the arthritic joint seen on the right may move easier and be less painful if synovial fluid viscosity improves. There is also evidence that the injections can help reduce inflammation in the joint.

As stated above, there are several brands available on the market today. Which one do we choose? This typically depends on your insurance company. We recommend checking with your insurance company prior to starting the authorization process to see what is on your formulary (preferred brand) and what your out-of-pocket expense will cost. The out-of-pocket cost varies between each insurance company. If you are interested in proceeding with this treatment, our staff will work on obtaining authorization through your insurance company and let you know directly once they are approved. They will get you scheduled to have these injections completed by one of our physicians or physician assistants. The number of injections varies depending on the brand. For the most part, the dose is spread out into three injections over a course of three weeks.

Viscosupplementation injections are administered in the clinic and most people can go about many of their activities later that day. Although a very safe procedure with very few side effects, we recommend that you minimize physical activity, such as exercise, for the remainder of the day after each injection. The fluid is thick, so the knee may be sore, minimally swollen and warm for the remainder of the day. We recommend icing the knee a few times that day to help reduce inflammation and use an NSAID (if permitted) and/or Tylenol to help with any discomfort. You may have a small amount of bleeding on your band aid from the needle stick. Although rare, you may develop a small bruise around the injection site as well. It is extremely rare to have significant increases in pain later that day or the next day. If it happens, please contact our office immediately to direct further care.

For the most part, each brand has similar outcomes with reduction in pain and improving function and have been clinically shown to delay the need for total joint arthroplasty. There is no magic cure though for treating knee arthritis and we do not expect a complete resolution in your pain. These injections can take up to 6 weeks from the last injection to get the full benefits. Their lasting effects may work for up to 6 months or even longer. Outcomes truly vary patient to patient. Our clinicians typically can repeat the series at least every 6 months.

Viscosupplementation injections are a safe and minimally invasive treatment in treating knee arthritis. If you would like to learn more about this treatment for knee arthritis, you are more than welcome to schedule an appointment with one of our clinicians for further discussion. Our office number is 412-782-3990, option 2. We hope to see you soon!