Visco supplementation is a procedure that involves injecting “Hyaluronic acid” normally derived from rooster comb or synthetically made into the knee. Hyaluronic acid is a naturally occurring substance found in the normal joint. It can be concentrated into a gel like substance that might presumably act as a lubricant. Currently, hyaluronate injections are approved for treatment of osteoarthritis of the knee in those who have failed to respond to more conservative therapy. Use for other joints is being investigated. It has been shown to provide about 6 months of pain relief in different studies.
Viscosupplementation could be considered in patients:
- Who have persistent pain despite the use of conservative therapy including weight loss, activity modification, physical therapy, Acetaminophen, anti-inflammatories, and cortisone injections.
- Who cannot tolerate anti-inflmmatories, have history of bleeding ulcers, or are taking concomitant blood thinners if they have not responded to cortisone injections.
- For whom surgery is not appropriate.
Viscosupplementation seems to work best in “early phases of arthritis” when there is still some cartilage left. If you have advanced knee arthritis with “bone to bone” changes, it is unlikely that you will benefit from Viscosupplementation. Also, there is no evidence that Visco supplementation is effective in treating meniscus tears, ligament tears, or other non-arthritic knee conditions. Viscosupplementation has not been shown to prevent knee arthritis from getting worse.
Administration of Hyaluronic acid could be associated with more pain and pressure sensation while being injected into the knee. It has also been associated with localized pain, itching, swelling, bruising and rashes that could occur later. These symptoms are usually minor and resolve within a few days. Occasionally the patient will have a severe reaction with marked swelling and pain that can take several days or weeks to resolve. There is also potential risk of infection though minor with each injection.
There are several brands of Hyaluronic acid available. A course therapy usually involves one injection per week for three weeks. There is no conclusive evidence that one brand of Hyaluronic acid is better than the other.