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Viscosupplementation For Arthritic Knees

Dr. Daniel Silver - Silver Orthopedics December 25, 2017

Men and women in the San Fernando Valley who suffer from arthritis of knee may find relief from chronic stiffness and pain through a medical solution known as viscosupplementation. But first, you may be wondering: What is viscosupplementation?

The answer lies in breaking down the meaning of the word. "Visco" refers to the thickness of a liquid. For example, cold syrup is more viscous than water. "Supplementation" means adding something. So, the word "viscosupplementation" means adding a viscous substance. Most commonly this thick liquid is injected into the knee, where it acts as a lubricant to allow a smoother less painful movement of the knee joint."

Indeed, for those suffering from arthritis in the knee, the reduction in friction on the surfaces of the knee, through injecting this lubricant bring about significant relief. Incidentally, the natural fluid in the knee joint is called synovial fluid and is made by the lining cells of the joint. Chemically it is high molecular weight hyaluronic acid (HA). Most of the viscous liquids available for injection, are able replace this natural hyaluronic acid (HA) with a similar substance. Before we get into the specifics of product recommendation, let's talk about who should get these injections.

Who is a Candidate for Viscosupplementation for Arthritic Knees?

Men and women in the San Fernando Valley may suffer from various types of arthritis, though most all will benefit from these injections. As men and women age, osteoarthritis is very common as years of wear and tear, can lead to this type of arthritis. A second type of arthritis is known as posttraumatic arthritis, which is typically caused by an injury, which may or may not have required surgery. Both osteoarthritis and posttraumatic arthritis result from a wearing down of the surface cartilage in the knee. As the surfaces wear, forces are transferred to the bone which has nerve endings. This pressure on the bone nerves hurts, resulting in pain and stiffness.

In people without arthritis, naturally present thick joint lubrication reduces this pain. However, for those with knee arthritis, the joint fluid is thinner, resulting in pain from simple movement such as walking or standing. Currently, it's estimated that over 27 million Americans have X-ray evidence of osteoarthritis and 12-16% will need treatment of the knee.

Knee arthritis typically presents with symptoms of pain with walking, standing, squatting, and kneeling. It is confirmed through X-rays which illuminate joint narrowing and spurs, both of which are common in patients with osteoarthritis and posttraumatic arthritis.

Treatments for the different types of arthritis in Encino include oral medication, bracing, physical therapy, and injections.

Types of Injections for Arthritis of Knee in Encino

There are two types of injections that can relieve pain from knee arthritis. One type of injection I use at Silver Orthopedics in Encino, to reduce pain and swelling is a cortisone derivative Depomedrol, and anesthetics Xylocaine and Marcaine. This injection provides temporary relief. If there is strong evidence of joint space narrowing on X-ray, a viscosupplementation injection (HA) is indicated. This latter injection is primarily for pain relief up to 6 months and can be repeated. Ultimately, men and women in the San Fernando Valley, who have joint space narrowing are eventually going to need Total Knee Arthroplasty (TKA) surgery, but these injections can delay that surgery for years.

There are many products on the market to help with lubrication of the knee joint. Some require 3-5 injections to be effective such as Synvisc, Suparz, Effexor, and others. There also are three products that are effective with one injection of high molecular weight hyalgan (HA). These products are Monovisc, Synvisc One, and Gel-One. The vast majority of these products are made from discarded rooster combs chemically treated and have been on the market for many years. There is a newer product called Monovisc now on the market, which is made from a carefully controlled bacterial process that produces the hyalgan (HA). Studies have shown very few side effects.

Costs are a consideration and are dealt with on a case by case basis. The financial advantage for the appropriate patient is that it delays the next step which would be a Total Knee Replacement. By receiving HA injections, it has been shown in some cases to delay the need for TKA for years. Theoretically, by delaying TKA for years it also reduces risk of needing a revision within the patient's lifetime. In sum, it is much cheaper and less risky have the HA injections than to undergo TKA immediately.

Injections for Arthritic Knees Available in the San Fernando Valley

It is my hope that this information is helpful for those of you suffering with knee pain, which has been confirmed as arthritis of the knee by X-ray. In just one appointment at Silver Orthopedics in Encino, we can determine if you are a candidate for this injection procedure.

Please call 818.784.9593 for a consultation at Silver Orthopedics in Encino today.