Viscosupplementation (hyaluronan injections)

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.

Viscosupplementation agents are injected directly into a joint by a qualified healthcare professional.

One injection into the involved joint. May be given once only or weekly for three to five weeks depending on affected joint and product used.

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 onset of relief is slower (several weeks) than with steroid injections, but the effect may last longer. This may vary from person to person. The duration of effect also varies from person to person and repeat viscosupplementation injections may be needed.

Do not use viscosupplementation products if you have had an allergy to hyaluronan preparations.

Do not use viscosupplementation products if you have a joint infection or an infection of the skin near the injection site.

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.

Routine blood tests are not required with viscosupplementation products.

Your healthcare provider may meet with you regularly to ensure that the viscosupplementation product is adequately controlling your OA pain and not causing adverse effects.

Store this medication according to the storage instructions listed on the package.