Viscosupplementation is a procedure where a fluid called hyaluronate or hyaluronic acid is injected into a joint.
Most viscosupplementation products contain ingredients like hyaluronic acid to help with lubricating the joints to prevent pain from joint friction. Some products, like Cingal®, are a combination of viscosupplementation and a corticosteroid to reduce inflammation and provide stronger pain relief.
Viscosupplementation injections are not routinely recommended for treatment of osteoarthritis (OA) due to limited benefits, risk of side effects and high costs of the various agents available.
These injections may sometimes be considered for osteoarthritis (OA) of the knee when first line agents have failed or are not tolerated.
Viscosupplementation is most beneficial for treatment of patients whose disease is in the initial stage (low level of osteoarthritis) and who use their joints more actively. Injections usually last several months, but some users can have benefits up to two years post injection.
The cost of viscosupplementation injections ($200 – $350/treatment course) can limit their use.
Viscosupplementation is not used in the management of inflammatory arthritis.
When hyaluronic acid is injected into a joint, it provides lubrication that can provide some pain relief. Hyaluronic acid can also promote the growth and development of the joint’s cartilage and bone.
Some products, like Cingal, are a combination of viscosupplementation and a corticosteroid to reduce inflammation and provide stronger pain relief.
The most common adverse events reported have been pain, swelling and/or inflammation in the injected knee.
There have been rare reports of viscosupplementation products causing a drop in blood counts and fever. People have also rarely reported pseudogout (sudden, painful swelling in one or more of your joints).
If possible, rest the joint for 48 hours after the injection.
If you experience discomfort in the joint after the injection you may treat the discomfort by applying a cold pack or by using medications, such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). Please check with your doctor.
Contributors
This information was last updated in June 2024 with expert review and advice by:
Alan Low, BSc(Pharm), PharmD, ACPR, FCSHP, CCD, RPh
Clinical Professor, Faculty of Pharmaceutical Sciences, University of British Columbia
Pharmacy Lead and Primary Care Pharmacist, BioPro Biologics Pharmacy
Care Director, MedInfuse Health
Garrett Tang, PharmD, RPh
Pharmacist Services Coordinator, MedInfuse Health
We also thank previous expert contributor:
Jason Kielly, BSc(Pharm), PharmD
Assistant Professor, School of Pharmacy, Memorial University of Newfoundland
Clinical Pharmacist, Rheumatic Health Program, Eastern Health
