What is viscosupplementation treatment for arthritis?

During viscosupplementation treatment for arthritis, your healthcare provider injects hyaluronic acid into your joint. This thick fluid may help ease pain and swelling in your knee. Hyaluronic acid is currently only approved for the knee.

The bones that make up your joints normally have a cap of cartilage on their ends. This cartilage helps make sure that your bones move smoothly against each other. This cartilage has a fluid coating that contains hyaluronic acid. This works like a lubricant and shock absorber in your joint.

In osteoarthritis (“wear-and-tear” arthritis), this cartilage cap breaks down. When this happens, the bones of your joint scrape together abnormally. People with osteoarthritis generally have less hyaluronic acid in their joints than they should. All of this causes symptoms like pain, stiffness, and swelling. The idea behind viscosupplementation is that replacing this hyaluronic acid may help reduce symptoms.

Your healthcare provider may first inject a numbing medicine into the space around your knee joint. They may drain any fluid that is causing the joint to swell. Then your provider will inject hyaluronic acid into the space inside your joint. You shouldn’t expect this to ease your pain right away. But after the full course of treatment, you may have some pain relief.

Why might I need viscosupplementation treatment for arthritis?

You may have already tried other treatments for your arthritis. These may have included over-the-counter pain medicines and corticosteroid injections. If you still have significant symptoms, viscosupplementation might be a good choice to help ease your pain, stiffness, and swelling. The treatment seems to work best in people with mild or moderate arthritis. It may make good sense if you're trying to delay getting surgery on your joint.

Generally, healthcare providers use viscosupplementation to treat osteoarthritis. But it may also help people with certain other kinds of arthritis, such as rheumatoid arthritis. Ask your provider if it's a choice for your type of arthritis.

What are the risks of viscosupplementation treatment for arthritis?

Most people don’t have any problems from viscosupplementation. But a small number of people do have problems.

The most common problem you might have is a flare-up of your arthritis just after your injection. This might cause more pain and swelling in the short-term. Healthcare providers are still learning about the best ways to help reduce the chances of this complication.

Less common risks include:

• Bleeding

• Allergic reaction

• Pain at the injection site

• Infection (delay your injection if you have any active infection to help prevent this)

There is also a chance that the treatment will not help your symptoms. Talk with your provider about all your concerns. Your own risks may vary according to your health conditions and where and how often you get injections.

How do I get ready for viscosupplementation treatment for arthritis?

Talk with your healthcare provider about all your health conditions. Tell your provider about all the medicines you take, including over-the-counter medicines, herbs, and supplements. Take all your medicines as normal, unless your provider tells you otherwise.

On the day of your procedure, you can eat and drink as you normally would. Tell your provider about any new symptoms such as fever. You may want to wear loose clothing so that you can easily uncover your joint. Your provider might give you other instructions about what to do before your procedure.

What happens during viscosupplementation treatment for arthritis?

Viscosupplementation is a quick procedure that you can likely have done during a normal office visit. In general:

• Your healthcare provider will clean the area where you’ll have your injection.

• Usually, your provider will inject a local pain killer (anesthetic) into the area around your joint. This is so you won’t feel any pain or discomfort in the area during the treatment. Your provider might use an anesthetic spray instead.

• In some cases, your provider might use imaging so that they can inject into exactly the right spot. Your provider might use ultrasound or another device that shows continuous X-rays.

• If you have extra fluid in your joint, your provider might remove a small amount of fluid before starting.

• Your provider will inject the hyaluronic acid into the joint space using a needle attached to a syringe.

• A small bandage will be put on your injection site.

Your provider can give you an even more specific idea of what to expect. Depending on the type of product used, you may not need another shot. Or you might need 1 to 4 more over the next few weeks.

What happens after viscosupplementation treatment for arthritis?

You should be able to go home shortly after your procedure. Ask your healthcare provider if it's OK for you to drive. For the next 48 hours, don't stand for long periods. Don't do lots of walking, jogging, or lifting heavy weights.

Some people have slight pain, warmth, and swelling right after their procedure. These symptoms often don’t last long. Using an ice pack may help. Tell your provider right away if these symptoms don’t go away soon. Also tell them if you have severe warmth, redness, pain, or high fever. Follow all your provider’s instructions about medicines and follow-up care.

Make sure to keep all your future appointments. The procedure may not work well if you don't get the full series of injections.

Don't expect the injection to ease your symptoms right away. It may take a few weeks to notice a difference. Symptom relief may last for a few months.

If this treatment doesn't ease your symptoms, you may be able to repeat the injection or series of injections in 6 months or so. But the procedure doesn’t help everyone. If it doesn’t work for you, talk with your provider about other treatment choices, such as joint surgery.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much will you have to pay for the test or procedure