Types of Viscosupplementation Injections: Get Relief From Knee Pain

Viscosupplementation Injections

If you suffer from knee osteoarthritis, you know how painful and wearing this condition can be. Simple activities like walking, climbing stairs, or getting in and out of chairs can become challenging. 

Viscosupplementation injection is often an effective treatment option for relieving osteoarthritis knee pain and getting people moving again.

What is Viscosupplementation, and How Do These Injections Work?

Viscosupplementation injections deliver a gel-like fluid called hyaluronic acid into the knee joint. Hyaluronic acid is a natural lubricant found in healthy joints. When osteoarthritis occurs this synovial fluid diminishes and produces friction in the joints, leading to knee pain.

According to the American Academy of Orthopedic Surgeons, hyaluronic injections provide several benefits to the joint. These include cushioning the joint, lubricating it, reducing inflammation, and promoting cartilage growth and repair.

Types of Viscosupplementation Injections

Viscosupplementation involves injecting hyaluronic acid derivatives into the knee joint to treat osteoarthritis. Several FDA-approved hyaluronic acid injections are available today. Let’s explore the main types of viscosupplementation injections:

1. Hyalgan

Hyalgan is the first hyaluronic acid injection approved for knee osteoarthritis in the United States. It is the oldest and most widely used type of viscosupplementation injection. It contains high molecular weight sodium hyaluronate, similar to natural joint fluid. 

Randomized controlled trials display the excellent safety and efficacy of this injection in lowering pain for most patients with knee osteoarthritis.

Onset of Action

Pain relief from Hyalgan begins within 24 hours to 2 weeks from the first of 5 injections.

Treatment Course

Doctors administer Hyalgan as 3-5 injections spaced one week apart, which provides pain relief for up to 6 months.

2. Supartz

Supartz hyaluronic acid injections contain sodium hyaluronate in a patented molecular weight (620 kDa-1170 kDa) optimized for increased flexibility and adherence to joint tissues. 

Doctors specially purify and filter it to achieve an optimal molecular weight range. It is a new injection made from a different type of hyaluronic acid than Hyalgan.

Onset of Action

Supartz begins relieving osteoarthritis knee pain within 1-2 weeks after the first injection.

Treatment Course

The Supartz regimen consists of 3-5 injections given at weekly intervals, providing up to 6 months of pain relief.

3. Euflexxa

Euflexxa contains sodium hyaluronate as its active ingredient, which undergoes chemical modification to enhance its properties. It is a combination injection that includes corticosteroid, triamcinolone acetonide, and hyaluronic acid. 

Doctors use corticosteroids to reduce inflammation, and hyaluronic acid to improve joint lubrication. This thicker fluid stays in the knee longer than other hyaluronic acid products, potentially relieving pain.

Onset of Action

Euflexxa can begin providing osteoarthritis knee pain relief within 1-2 weeks after the first injection.

Treatment Course

Doctors administer Euflexxa as a 3 injection regimen, giving shots 1 week apart. It provides pain relief for up to 26 weeks.

4. Orthovisc

Orthovisc utilizes a high molecular weight hyaluronan molecule called Hylan G-F 20. Its long polymer structure and complex cross-links help reinforce joint tissues. This formulation provides more elasticity and shock absorption than traditional hyaluronans to improve joint lubrication and comfort. 

Clinical trials display at least six months of significant pain relief and functional improvement with this injection. Over 80% of patients rated it superior to saline placebo injections.

Onset of Action

Orthovisc starts working within 2-3 weeks to relieve osteoarthritis knee pain.

Treatment Course

Doctors administer Orthovisc as a 3-4 injection series with shots spaced one week apart. It gives up to 6 months of pain relief.

5. Synvisc

Synvisc is one of the types of knee injections viscosupplementation, made from a thick hyaluronic acid to help with knee problems. This widely used viscosupplement also contains hylan G-F 20. Its viscoelastic properties support shock absorption, lubrication, and tissue protection. 

Synvisc has proven benefits over other treatments, like anti-inflammatory drugs, NSAIDs, and corticosteroid injections. It also delays knee arthroplasty surgery longer than conservative measures alone.

Onset of Action

Synvisc relieves osteoarthritis pain within 1-4 weeks after the first three injections.

Treatment Course

The Synvisc treatment course consists of 3 injections spaced one week apart, delivering up to 6 months of pain relief.

How are Viscosupplementation Injections Given?

Viscosupplementation knee injections are quick, in-office procedures. The doctor will clean the knee injection site and then use a thin needle to put medicine into the joint.

  • Once properly positioned, rheumatologists slowly inject the gel into the knee joint capsule.
  • You may feel pressure or aching as the joint expands, but injections are generally not too painful.
  • After the injection, they will monitor you for 15-30 minutes to ensure no adverse reactions. 
  • At last, your doctor will provide instructions on how to take care of yourself. 
  • These instructions may include ice, resting, compression, and over-the-counter pain medication.

Depending on the specific viscosupplement used, you may need several repeat injections spaced 1-2 weeks apart.

How Effective Are These Knee Gel Injections?

Clinical studies show the various hyaluronic acid preparations used in knee injections provide significant osteoarthritis symptom relief for many patients. Benefits may include:

  1. 50-80% reduced pain in the knee
  2. Improved ability to walk, bend, and climb stairs
  3. Increased joint mobility and flexibility
  4. Delayed progression of further joint damage
  5. Potential to avoid or delay knee replacement surgery 

Results of injections vary by patient characteristics like age, disease severity, and product used. 

According to the National Institute of Health, relief from injections can start in 2-4 weeks and may continue for 6 months or more. Patients can repeat treatment as needed every 6-12 months.

Effective Are These Knee Gel Injections?

Risks and Potential Side Effects

Viscosupplementation knee injections are incredibly safe overall, with a low-risk profile. However, some potential side effects may occur. 

  • Common temporary side effects include mild pain, swelling, or bruising at the injection site. The use of ice packs can help reduce inflammation.
  • Less common risks include joint stiffness, headaches, dizziness, rash, itching, or nausea.
  • Rare serious complications like infections or allergic reactions are highly unlikely but require prompt medical care if they occur. 

Always follow your doctor’s post-procedure instructions to care for your knee after injections. Contact your healthcare provider if you have any concerns about adverse reactions.

Risks and Potential Side Effects

Thinking of getting Viscosupplementation Injections?

Contact our physicians at SNS Rheumatology to evaluate if you might benefit from viscosupplementation or alternative therapies for managing your osteoarthritis.

Wrapping Up

There are 5 FDA-approved types of viscosupplementation injections: Hyalgan, Supartz, Euflexxa, Orthovisc, and Synvisc, offering options for safe, effective knee pain treatment.

Viscosupplementation injections can bring substantial pain relief and renewed mobility for people with knee arthritis.

But first talk to your doctor about the pros and cons of knee gel injections, then decide if they are right for you.

Dr. Qaisar Usmani

Meet Dr. Qaisar Usmani, a Board Certified Rheumatologist with over 20 years of experience in the field, currently serving as Section Chief at Monmouth Medical Center and GPHA, Inc. in Pennsylvania, specializing in the treatment of various Rheumatic and Musculoskeletal diseases.

Dr. Sadia Ghafoor
Dr. Sadia Ghafoor

Meet Dr. Sadia Ghafoor, a board certified specialist in rheumatology who completed her medical training at the University of Medicine and Dentistry School of Osteopathic Medicine and her fellowship in rheumatology at the State University of New York Stony Brook campus, with additional board certification in internal medicine.

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