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What Is Viscosupplementation?

Normal joint fluid contains a substance called hyaluronan (hyaluronic acid). Hyaluronan is highly viscous, allowing the cartilage surfaces of the bones to glide upon each other smoothly.

When a joint is affected by osteoarthritis, the level of hyaluronic acid within the joint fluid decreases. This decreased level of hyaluronic acid causes the synovial fluid of the joint to be thinner and reduces the joint's ability to lubricate itself. Viscosupplementation is often required in these cases.

Without the protective and lubricating effect of hyaluronan in the synovial fluid the result is painful rubbing of cartilage within the joints. Eventually, if the cartilage is allowed to wear down, the bones within the joint will start to rub together.

Viscosupplementation with hyaluronic acid products such as Synvisc, Hyalgan and Orthovisc replaces the damaged synovial fluid of the joint. Viscosupplementation can improve the cushioning and lubricating effects of synovial fluid.

Another name for viscosupplementation is synovial fluid replacement.

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What viscosupplements are currently available?

Here is a list of viscosupplements:

Synvisc
Hyalgan
Orthovisc
Neovisc
Supartz
Euflexxa
Durolane
Suplasyn

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What Joints Can Viscosupplementation Be Used On?

At this time viscosupplementation has only been FDA-approved for the knee joint. The use of viscosupplements in other joints has not yet been approved.

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What is Viscosupplementation Used For?

Viscosupplements are used for the treatment of osteoarthritic knee pain. Viscosupplementation can be very useful in osteoarthritis of the knee. Viscosupplements can help reduce the pain in a knee affected by osteoarthritis, increasing mobility and allowing more activity. These treatments can be injected into both knees or just a single knee joint.

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How Do I Receive Viscosupplementation treatment?

In order to receive viscosupplementation you will need to be assessed by your physician. Your physician can refer you to a specialist, usually a Rheumatologist or an Orthopedic surgeon, who can determine whether or not viscosupplementation is right for you. The specialist will also be able to decide which viscosupplement is most appropriate for you.

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Who is eligible to get Viscosupplementation?

Viscosupplementation can be considered if you have not found pain relief from:

  • Exercise
  • Physical therapy
  • Weight loss
  • Use of heat (for example, from a heating pad) and cold (for example, from an ice pack)
  • Use of a cane or orthotics (such as a heel wedge and other products that relieve the pressure on the knee) and
  • Use of analgesics, including acetaminophen (for example, Tylenol); aspirin; prescription or nonprescription nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (for example, Advil, Motrin) and naproxen (for example, Aleve); the prescription drugs rofecoxib (Vioxx) or celecoxib (Celebrex); or corticosteroid injections

Viscosupplementation might be right for you if you:

  • Are not receiving adequate pain relief from current treatment
  • Cannot take aspirin or other anti-inflammatory drugs like ibuprofen
  • Are already taking multiple medications
  • Are not an appropriate candidate for knee surgery

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How is Viscosupplementation Done?

The viscosupplements come in an injectable form. The procedure involves injecting the viscosupplement liquid into the knee with a needle. The viscosupplementation procedure is done in your doctor’s office and only takes a couple of minutes.

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How many viscosupplement injections are required?

With Synvisc injections, a total of 3 injections are given, one viscosupplement injection every week for three weeks. With Hyalgan injections and Supartz injections a total of five injections are needed, one viscosupplement injection every week for 5 weeks.

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What are some side effects of Viscosupplementation?

The most commonly reported side effects associated with the viscosupplementation injections are temporary injection-site pain, swelling, heat and/or redness, rash and itching, bruising around the joint and/or fluid accumulation in the injected knee. These reactions to viscosupplement injections are usually mild (occasionally can be severe) and do not last long. You should avoid any strenuous activities or prolonged (more than 1 hour) weight-bearing activities (such as jogging or tennis) for 48 hours following the viscosupplementation injection.

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Will viscosupplementation cure my osteoarthritic knee?

The viscosupplementation procedure will not cure osteoarthritis of the knee. Viscosupplementation simply improves the lubricating properties of the synovial fluid, reduces or stops the pain from knee osteoarthritis, improves mobility and provides a more comfortable level of activity. Viscosupplementation treatment is usually required every 6 months.

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How long do the positive effects of the viscosupplementation treatment last?

According to studies, the viscosupplements Synvisc and Hyalgan have been proven to provide pain relief from osteoarthritis of the knee for up to 6 months. Some patients have had the benefit last for more than 6 months. Supartz was shown to provide pain relief up to 4½ months following the final injection (of the 5 injection series).

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What additional health information should I give my physician before I receive the viscosupplement treatment?

Before beginning viscosupplement treatment, let your physician know if you are allergic to products from birds (such as feathers, eggs, or poultry).

You should not receive viscosupplement injections if you have a known allergy to sodium hyaluronate preparations or you have an infection or skin disease in the area of the injection site.

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Are viscosupplements considered to be a drug?

Viscosupplements are classified as medical devices.

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