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Viscosupplementation with Hyaluronic Acid

By

Megan Freedman

What is viscosupplementation with hyaluronic acid?

Viscosupplementation with hyaluronic acid is a treatment for symptoms of osteoarthritis. Natural hyaluronic acid helps lubricate and cushion joints. People with osteoarthritis have less hyaluronic acid in their joint fluid than normal. Viscosupplementation with hyaluronic acid involves injecting synthetic joint lubricant into the affected joint. This can help reduce inflammation and pain in joints, such as the knee, hip, shoulder and wrist.

Viscosupplementation does not cure osteoarthritis but can reduce symptoms, including inflammation and pain. Viscosupplementation may also signal the body to produce more of its own natural hyaluronic acid. Viscosupplementation is only one method used to treat osteoarthritis. Discuss all of your treatment options with your doctor to understand which options are right for you.  

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Other procedures that may be performed

Your doctor will likely recommend one or more complementary treatments or lifestyle modifications along with viscosupplementation with hyaluronic acid. These can include physical therapy, exercise, or assistive devices such as braces or canes. Recommendations will vary depending on the extent of your joint’s deterioration, your age, your symptoms, and other factors. 

Why is viscosupplementation with hyaluronic acid performed? 

Doctors most frequently use viscosupplementation to treat osteoarthritis in the knees. They also use it to treat symptoms in other joints, such as the hip, shoulder and wrist. 

Osteoarthritis is a progressive disease that causes inflammation, pain, stiffness and swelling of joints. The joints of the body are the areas where two or more bones meet. The ends of the bones are protected by a tissue called cartilage, which helps bones to move easily without damaging bone tissue. 

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Osteoarthritis occurs when the cartilage breaks down or becomes torn or thin. The synovial fluid also loses its ability to lubricate the joint. This results in friction on the ends of the bones as they rub against each other. With time, this causes the classic symptoms of osteoarthritis, such as joint pain, stiffness and swelling.

Your doctor may only suggest viscosupplementation after you have tried other treatments to help your osteoarthritis symptoms, such as over-the-counter pain medication and lifestyle changes.

Who performs viscosupplementation with hyaluronic acid?

Orthopedic surgeons and rheumatologists perform viscosupplementation with hyaluronic acid. An orthopedic surgeon specializes in the medical and surgical treatment of diseases and conditions of the bones, joints, and connective tissues. A rheumatologist specializes in diagnosing and treating arthritis and other rheumatic diseases. Rheumatic diseases affect your joints, tendons, ligaments, bones or muscles.

How is a viscosupplementation with hyaluronic acid performed?

Your viscosupplementation with hyaluronic acid injection will be performed in an outpatient setting, such as the doctor’s office. 

The procedure generally includes these steps:

  1. Your doctor or care team will clean the injection site.

  2. Your doctor will insert a needle into your joint and withdraw synovial (joint) fluid.

  3. Your doctor will inject synthetic hyaluronic acid into your joint.

  4. Your doctor will repeat this process once a week for a few weeks. The time between injections and number of injections during the course of treatment depends on the type of synthetic hyaluronic acid that your doctor uses.

  5. You will likely go home soon after your viscosupplementation with hyaluronic acid injection.

Will I feel pain?

Your comfort and relaxation is important to both you and your care team. You will feel a brief pinch or prick during the needle insertion. Your healthcare team will give you sufficient pain and sedative medications if you need them to stay comfortable. Tell your doctor or care team if you are uncomfortable in any way.

What are the risks and potential complications of viscosupplementation with hyaluronic acid?  

Complications after viscosupplementation with hyaluronic acid are not common, but any procedure involves risks and the potential complications. Complications may become serious in some cases. Complications can develop during the procedure or your recovery. Risks and potential complications of a viscosupplementation with hyaluronic acid include: 

  • Adverse reaction to the synthetic hyaluronic acid, such as an allergic reaction and problems with breathing

  • Bleeding or bruising

  • Damage to nerves and blood vessels

  • Infection

  • Injection site reactions including swelling, tenderness and warmth. These are usually temporary.

  • Pain

Reducing your risk of complications

You can reduce the risk of certain complications by: 

  • Following activity, dietary and lifestyle restrictions and recommendations before your injections and during recovery

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my viscosupplementation with hyaluronic acid?

You are an important member of your own healthcare team. The steps you take before your viscosupplementation with hyaluronic acid injection can improve your comfort and outcome. You can for viscosupplementation with hyaluronic acid by:

  • Answering all questions about your medical history, allergies, and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.

  • Taking or stopping medications exactly as directed. Your doctor will give you instructions for taking your specific medications and supplements.

Questions to ask your doctor

Having a viscosupplementation with hyaluronic acid injection can be stressful. It is common for patients to forget some of their question during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need viscosupplementation with hyaluronic acid? Are there any other options for treating my osteoarthritis?

  • How long will each treatment take? When can I go home?

  • How many treatments will I need? When will my treatments occur?

  • What restrictions will I have after the injections? When can I return to work, exercise, and other activities?

  • How often will I need injections? How far apart will they occur?

  • What kind of assistance will I need at home? Will I need a ride home?

  • What medication plan should I follow before and after the procedure? 

  • How will you treat my pain?

  • When and how will we know if the treatment is working?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my viscosupplementation with hyaluronic acid?

Knowing what to expect after viscosupplementation with hyaluronic acid can help you get back to your everyday life as soon as possible.

How will I feel after viscosupplementation with hyaluronic acid?

You may have discomfort and swelling near your injection site for the first two to three days after the procedure. Applying an icepack can help ease minor discomfort. Your doctor will recommend or prescribe medication to control your pain as needed. Tell a member of your care team if your pain is not well controlled by your medication because it can be a sign of a complication.

Your doctor will likely advise you to avoid sports, exercise, and putting a lot of weight on your affected joint for the first few days. You should feel less pain and swelling in your affected joint a few weeks after your treatment, with maximum relief occurring within about three months. Pain relief is generally temporary, lasting up to six months after the injections.  

When can I go home?

You will likely go home right after your viscosupplementation with hyaluronic acid injection.

When should I call my doctor?

It is important to keep your follow-up and physical therapy appointments after a viscosupplementation with hyaluronic acid injection. Contact your doctor for questions or concerns between appointments. Call your doctor right away if you have:

  • Bleeding

  • Fever

  • Pain that is not controlled by your pain medication

  • Difficulty breathing

  • Dizziness or fainting

  • Drainage from the injection site

  • New or unexplained symptoms

  • Skin changes, such as rash or skin irritation

  • Swelling, warmth or redness

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 8, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Arthritis of the Knee. American Academy for Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00212
  2. Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis. American Family Physician. http://www.aafp.org/afp/2000/0801/p565.html
  3. Osteoarthritis. American College of Rheumatology. http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Osteoarthritis/
  4. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: A systematic review and meta-analysis. Arthritis and Rheumatism. http://www.ncbi.nlm.nih.gov/pubmed/19950318
  5. Viscosupplementation. Cleveland Clinic. http://my.clevelandclinic.org/services/viscosupplementation/hic_viscosupplementation.aspx
  6. Viscosupplementation in the hip: evaluation of hyaluronic acid formulations. Archives of Orthopaedic and Trauma Surgery. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2228384/
  7. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Annals of Internal Medicine. http://www.ncbi.nlm.nih.gov/pubmed/22868835
  8. Viscosupplementation Treatment for Arthritis. American Academy for Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00217

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