It is our normal practice at OSC to begin with conservative care and exhaust all treatment options before recommending surgical intervention. We will recommend that patients change their activity levels, take pain relievers and/or anti-inflammatory medications, participate in physical therapy or undergo cortisone injections.
An additional conservative option that may be recommended is visco-supplementation, improperly referred to as “cartilage replacement injections.” It is currently not possible to replace cartilage, so please be weary if a medical provider tells you that is what he/she does.
At OSC, we use visco-supplementation to treat painful, arthritic knees. There are several brand names for the visco-supplements (Hyalgen, Supartz, Synvisc, Euflexa), but the goals are the same for their use. Each of this type of injection is intended to lubricate the rough, arthritic cartilage in the knee joint, so the joint moves more easily and therefore has less grinding and irritation.
What exactly is Visco-Supplementation?
Visco-supplementation is a procedure in which a naturally-occurring substance, called hyaluronic acid, is injected into the knee joint. Hyaluronic acid is a thick fluid that is present in our joint (synovial) fluid which helps our bones to move smoothly over each other, acting as a lubricant. People with osteoarthritis have a low concentration of hyaluronic acid in their joints, so visco-supplementation may be a good option to relieve pain and improve function. The visco-supplementation injections can be repeated, with similar results, about every 6 months.
What are the effects of Visco-Supplementation?
There are several studies that have shown good patient responses when using visco-supplementation in the knee joint.
• An Italian study looked at early arthritis of the knee treated with these injections and found patients were able to walk in a more balanced manner, due to less pain, AND reduce their risk of falls that would lead to fractures.
• A British study looked at 4,400 patients treated with visco-supplementation injections for moderate arthritis. A greater than 40% pain reduction was seen after the injections and the average patient’s functional improvement was 46%. These patients were finding they were able to be almost 50% more active without pain. This is a great result for patients with painful, arthritic knees.
• Another February 2012 report indicates the same results as the previously mentioned British study.
Osteoarthritis is the “wear and tear” arthritis, and for those who suffer from it, at some point, the knee will become too worn-out for these medications and injections to provide comfort. When this happens, surgery will need to be considered. If surgical intervention can be put off for a while, especially while we are younger and more physically fit, treatment technologies may also be developed to provide more alternatives to surgery or which may improve the surgical alternative.
Click here to read an article written about visco-supplementation by Dr. Carlson.
If you would like to schedule a consultation with an orthopaedic specialist about your knee pain, please call OSC at 757-596-1900.
Return to the Knee Care page.