Types of Viscosupplementation Injections Demystified

July 4, 2024

Discover types of viscosupplementation injections, their effectiveness, and what to consider before opting for one.

Understanding Viscosupplementation Injections

When it comes to managing knee pain associated with osteoarthritis, viscosupplementation injections have emerged as a popular option. This treatment involves the injection of hyaluronic acid into the knee joint. But how does it work? Let's delve deeper into the concept and mechanism of viscosupplementation injections.

What is Viscosupplementation?

Viscosupplementation is a medical procedure that involves the injection of hyaluronic acid into a joint. Although it can be used for various joints, it's most commonly used for the knee. This treatment aims to alleviate pain associated with osteoarthritis by acting as a lubricant and facilitating smooth bone movement Drugs.com.

Hyaluronic acid, a naturally occurring substance in the synovial fluid of joints, serves as a lubricant and shock absorber. In individuals with osteoarthritis, the amount of hyaluronic acid tends to be lower than usual, causing discomfort and pain. Viscosupplementation injections supplement the joint with this critical substance, helping to restore joint function and ease pain.

How Do Viscosupplementation Injections Work?

Viscosupplementation injections work by restoring the physiologic viscoelasticity in the synovial fluid, typically in the absence of inflammation. The injected hyaluronic acid serves as a lubricant, facilitating smooth movement of the bones and reducing friction Source.

Moreover, hyaluronic acid has been shown to downregulate pro-inflammatory factors and proteases known to break down the joint matrix. This reduction in inflammation and joint degradation can help alleviate the pain and discomfort associated with osteoarthritis Source.

Typically, a trained health professional administers viscosupplementation injections as a shot into the knee joint. The treatment usually involves a series of shots given one week apart for a total of three or four injections Mayo Clinic.

It's important to note that temporary pain or swelling in the knee joint may occur following a hyaluronic acid injection. Therefore, it's recommended to avoid strenuous activities like jogging, soccer, tennis, heavy lifting, or prolonged standing for two days after the treatment Mayo Clinic.

Understanding viscosupplementation and how it works is the first step in exploring the various types of viscosupplementation injections and their potential benefits in managing osteoarthritis-related knee pain. The rest of this article will delve deeper into the different types of injections, their administration and effectiveness, and considerations and contraindications for the treatment.

Types of Viscosupplementation Injections

Understanding the different types of viscosupplementation injections can help one make an informed decision about their knee treatment options. Here, we'll explore Hylan g-f-20, Sodium Hyaluronate preparations, Single-Use Agents, and Hyaluronan Formulations.

Hylan g-f-20

Hylan g-f-20 is a cross-linked product derived from rooster comb HA (Hyaluronic Acid). It has a high molecular weight (6000 kDa). This formulation mimics naturally occurring HA, reducing pain perception, promoting the synthesis of extracellular matrix proteins, and suppressing inflammatory mediators.

Sodium Hyaluronate Preparations

Sodium Hyaluronate preparations, including Suparts Fx, Euflexxa, Gelsyn-3, Durolane, and Hyalgen, are safe and effective for treating knee osteoarthritis. They provide pain relief, improve functionality, and potentially delay the need for knee replacement surgery. Adverse effects are generally mild and similar to other viscosupplements.

Single-Use Agents

Single-use agents, such as Gel-One, Synvisc-One, and Monovisc, are another type of viscosupplementation injections. These agents are designed for a one-time use, making them an ideal choice for patients seeking a convenient treatment option.

Hyaluronan Formulations

Orthovisc, Monovisc, and Hymovis are different brand-name formulations of hyaluronan used for intraarticular injection in the management of knee osteoarthritis. These formulations have different molecular weights and administration regimens.

In summary, there are several types of viscosupplementation injections available, each with their own unique properties and benefits. It's important to discuss these options with a healthcare provider to determine which type of injection is most suitable for your specific needs.

Type of Injection	Examples
Hylan g-f-20	N/A
Sodium Hyaluronate Preparations	Suparts Fx, Euflexxa, Gelsyn-3, Durolane, Hyalgen
Single-Use Agents	Gel-One, Synvisc-One, Monovisc
Hyaluronan Formulations	Orthovisc, Monovisc, Hymovis

Figures courtesy PubMed Central

Administration and Effectiveness

Understanding the administration process and effectiveness of viscosupplementation injections is key to making an informed decision about this treatment option. Here, we discuss the injection process, efficacy, and duration of pain relief associated with these injections.

Injection Process

Viscosupplementation injections are typically administered by a trained health professional as a shot into the knee joint. A series of shots are given one week apart for a total of three or four injections, depending on the type of viscosupplementation used (Mayo Clinic). The process is relatively quick, and patients can usually resume normal activities soon after the procedure.

Efficacy of Viscosupplementation

Studies have indicated significant pain level improvement in arthritic hip and knee populations after viscosupplementation. However, no prospective, randomized, double-blinded studies have proven any advantage of hyaluronic acid injections when compared with corticosteroid injections. That being said, viscosupplementation may be an effective treatment for knee osteoarthritis, superior to placebo with respect to pain, function, and patient global assessment. The response to viscosupplementation may have a later onset but a more durable response compared to other treatments.

One of the types of viscosupplementation injections, Hylan g-f20, may be a particularly effective interventional treatment for knee OA and may delay the need for total knee replacement surgery. The clinical benefit of Hylan g-f20 seems to be most noticeable two to nine months following the initiation of treatment (PMC).

Duration of Pain Relief

The evidence suggests that viscosupplementation allows for reduced administration of opioid analgesics and NSAIDs, with an improved risk/benefit ratio, and may delay joint replacement. It has shown to have a later onset of clinical efficacy (1–4 weeks) compared to corticosteroids, but the effect can be maintained for 6 or even 12 months (ScienceDirect).

This longer duration of pain relief can be a significant advantage for those suffering from chronic knee pain due to osteoarthritis. However, individual responses can vary, and some patients may require repeat treatment series for continued symptom relief.

In conclusion, the administration and effectiveness of viscosupplementation injections are important considerations for patients seeking relief from knee osteoarthritis symptoms. Understanding the potential benefits and limitations can help patients make informed decisions about their treatment options.

Considerations and Contraindications

Before exploring the different types of viscosupplementation injections, certain patient considerations and contraindications should be taken into account.

Patient Considerations

Viscosupplementation injections are primarily recommended for individuals with chronic moderate symptomatic osteoarthritis (OA), and not for acute flares with joint swelling. The application of these injections in sport-related chondropathy requires further assessment, and the optimal patient response profile is still under investigation.

While the knee is the standard injection site for viscosupplementation treatment, it may also be used for arthritis in other joints such as the hip or other locations based on the healthcare provider's recommendation. However, it's worth noting that results for hip osteoarthritis have been widely variable, with some studies showing promising results, and others demonstrating disappointing outcomes.

Moreover, the literature regarding the efficacy of hyaluronic acid for hip osteoarthritis shows large heterogeneity and conflicting results, and current clinical guidelines do not recommend hyaluronic acid injections for hip osteoarthritis management.

Contraindications to Viscosupplementation

While viscosupplementation injections can be beneficial for many patients with osteoarthritis, there are certain contraindications to be aware of. Specifically, these injections are not recommended for individuals with acute joint swelling or severe OA.

Furthermore, while approved by the Food and Drug Administration (FDA) for use at the knee, it's important to note that the use of viscosupplementation injections for other joints, such as the hip, is not officially approved. However, some initial studies indicate that image-guided hip joint viscosupplementation injections are well tolerated, safe, and beneficial for hip osteoarthritis [4].

Recognizing these considerations and contraindications is crucial in determining the best course of action for each individual patient. By doing so, healthcare providers can ensure that they are providing the most effective and appropriate treatment for their patients' unique needs.

Side Effects and Adverse Events

While viscosupplementation injections can offer relief for many patients suffering from knee pain, it's important to be aware of potential side effects and adverse events associated with these treatments.

Common Side Effects

After receiving hyaluronic acid injections, one of the types of viscosupplementation injections, patients may experience temporary pain or swelling in the knee joint. As a result, activities such as jogging, soccer, tennis, heavy lifting, or prolonged standing should be avoided for at least two days after the procedure.

Other common side effects may include:

Pain at the injection site
Local skin reactions
Local joint pain and swelling

Patients are advised to contact their doctor if they experience persistent or worsening pain or swelling in the knee joint after the injection.

Adverse Events to Watch For

Although adverse events associated with viscosupplementation are usually mild, local, and transient, with minimal risk of serious complications, there are some potential risks to be aware of.

These include:

Pseudoseptic reactions
Septic arthritis
Arthritis flare-ups post-injection
Ineffectiveness of treatment in alleviating symptoms

Healthcare providers continue to learn about techniques to reduce these complications.

It's important to note that certain patients may be contraindicated for hyaluronic acid injections, including those with known hypersensitivity to hyaluronic acid products, pediatric patients, bacteremic patients, and those with an active local infection in the target joint of the injection [1].

The decision to pursue viscosupplementation injections should be made in consultation with a healthcare provider, who can discuss the potential benefits and risks in the context of the patient's specific condition and overall health.

Future of Viscosupplementation

As medicine continues to advance, so too does the development and application of treatments such as viscosupplementation. Let's delve into what the future may hold for this form of treatment.

Research and Development

Viscosupplementation injections are approved by the Food and Drug Administration (FDA) only for use in the knee. However, ongoing research and development efforts are exploring their potential applications in other joints, with some promising results. For instance, initial studies indicate that image-guided hip joint viscosupplementation injections are well tolerated, safe, and beneficial for hip osteoarthritis.

Further studies are indicated to determine the response profile and optimal treatment schedule according to the joint. While results have generally been disappointing in hip osteoarthritis, they have been promising in osteoarthritis of the ankle and shoulder (with and without rotator cuff tear) [2].

Potential Applications Beyond Knee Osteoarthritis

Currently, the knee is the standard injection site for viscosupplementation treatment. However, research suggests that it may also be used for arthritis in other joints such as the hip or other locations based on the healthcare provider's recommendation.

Evidence indicates that viscosupplementation allows reduced administration of opioid analgesics and NSAIDs, with an improved risk/benefit ratio, and may delay joint replacement. It has shown to have a later onset of clinical efficacy (1–4 weeks) compared to corticosteroids, but the effect can be maintained for 6 or even 12 months.

However, the literature regarding the efficacy of hyaluronic acid for hip osteoarthritis shows large heterogeneity and conflicting results, and current clinical guidelines do not recommend hyaluronic acid injections for hip osteoarthritis management [4].

In conclusion, while viscosupplementation is a promising treatment for knee osteoarthritis, further research is necessary to establish its efficacy and safety in treating osteoarthritis in other joints. As research continues, it is hoped that the scope of viscosupplementation treatment will expand, offering relief to a wider range of patients suffering from joint pain due to arthritis.