Viscosupplementation vs Cortisone for Knee Pain Management

July 4, 2024

Compare viscosupplementation vs cortisone for knee pain relief, understand their efficacy, side effects, and more.

Understanding Viscosupplementation

Viscosupplementation is a treatment method that has garnered attention in the field of knee pain management. It presents a possible alternative to traditional interventions such as cortisone injections.

What is Viscosupplementation?

Viscosupplementation is a procedure that involves the injection of hyaluronic acid (HA) into the affected joints. The primary goal of this treatment is to restore the physiologic viscoelasticity in the synovial fluid when inflammation is absent. Hyaluronic acid has also been shown to downregulate pro-inflammatory factors, such as PGE2 and NFkB, and proteases and proteinases known to degrade the joint matrix.

Several brand-name formulations of hyaluronan, such as Orthovisc, Monovisc, and Hymovis, are used for intraarticular injection in the management of knee osteoarthritis. Viscosupplementation is most effective for patients with mild-to-moderate joint degeneration but isn't suggested for individuals with severe, end-stage, or bone-on-bone arthritis.

Effectiveness of Viscosupplementation

The efficacy of viscosupplementation (VS) in pain reduction and improved functionality has been found to be superior to NSAIDs and corticosteroids. However, there is variability in the existing evidence base, leading to guidelines neither recommending for nor against its use.

Evidence suggests that Hylan g-f20, a specific type of HA used in viscosupplementation, may effectively treat knee osteoarthritis and potentially delay the need for total knee replacement surgery. The clinical benefits of Hylan g-f20 are most noticeable two to nine months following the initiation of treatment.

Adverse effects reported with viscosupplementation include arthralgia, arthropathy/arthrosis/arthritis, back pain, injection-site reaction/pain, and headache. However, these reactions are often mild to moderate in severity, making viscosupplementation a generally safe and effective treatment method for healthy adults.

It's important to note that viscosupplementation doesn't provide immediate pain relief and isn't an anti-inflammatory treatment. Instead, it may stimulate the body to produce more of its own natural hyaluronic acid, helping to reduce symptoms related to osteoarthritis, such as pain and swelling [2].

Exploring Cortisone Injections

As we delve into the comparison of viscosupplementation vs cortisone for knee pain management, a detailed understanding of cortisone injections is crucial. These injections are a widely utilized treatment option for a variety of conditions, offering significant relief for numerous patients.

Cortisone Injection Basics

Cortisone injections, often simply referred to as cortisone shots, are commonly used in the treatment of many joint-related conditions. These injections are most often administered into joints like the elbow, hip, knee, shoulder, spine, or wrist. Smaller joints in the hands or feet can also benefit from these injections, reinforcing their versatility in application [3].

The primary aim of cortisone injections is to reduce pain and swelling in various injuries and conditions. The duration of relief provided by cortisone can vary, with some people experiencing relief for several days to over six months. It's also worth noting that repeated cortisone injections over several years may help improve symptoms or delay the need for surgery in some cases.

Conditions Treated with Cortisone

Cortisone injections are commonly used to treat a wide array of conditions. These include, but are not limited to, osteoarthritis, lower back pain, carpal tunnel syndrome, bursitis, and tendonitis. Moreover, these injections are also used to manage conditions stemming from autoimmune diseases, where inflammation is the underlying issue.

The effectiveness of cortisone injections may also vary based on the severity of the patient's condition. As per Coastal Orthopedics, cortisone injections are recommended for individuals with moderate-to-severe pain, while viscosupplementation is recommended for individuals with mild-to-moderate osteoarthritis.

Condition	Recommended Treatment
Moderate-to-severe pain	Cortisone injections
Mild-to-moderate osteoarthritis	Viscosupplementation

Understanding the conditions that cortisone injections can treat and the relief they provide is essential when comparing these injections with viscosupplementation. Both methods offer unique advantages and may be more suitable for certain conditions or levels of pain.

Comparing Pain Relief Methods

When examining the efficacy of viscosupplementation and cortisone injections in managing knee pain, two key factors to consider are the duration of pain relief and the improvement in symptoms.

Duration of Pain Relief

Research suggests that hyaluronic acid (HA), a type of viscosupplementation, offers a longer duration of pain relief compared to cortisone injections for the treatment of knee osteoarthritis. According to a study cited by PubMed Central, HA can be administered every 3 months intra-articularly for knee joint osteoarthritis, while cortisone has to be injected every 2 months.

The study further found that HA had a more durable efficacy compared to cortisone, with pain relief lasting for more than 3 months. On the other hand, the results of cortisone shots can vary based on the reason for treatment, with common short-term flares in pain, swelling, and irritation for up to two days, followed by pain relief lasting several months.

Efficacy in Symptom Improvement

In terms of symptom improvement, a study comparing the effectiveness of intra-articular hyaluronic acid (HA) and corticosteroid (CS) injections for knee osteoarthritis found that both treatments improved symptoms after 3 months. However, the durability of pain relief was significantly longer with HA compared to CS [6].

The Western Ontario McMaster University Osteoarthritis (WOMAC) score, a widely used set of standardized questionnaires used by health professionals to evaluate the condition of patients with osteoarthritis of the knee and hip, indicated that pain and stiffness did not improve in either group, but physical function improved significantly in both groups after 3 months [6].

In conclusion, while both viscosupplementation and cortisone prove to be effective in relieving knee pain and improving physical function, viscosupplementation provides a longer duration of relief. However, individual responses to treatment can vary, and the choice between viscosupplementation and cortisone should be made in consultation with a healthcare provider, taking into account the patient's specific condition and needs.

Safety and Side Effects

While both viscosupplementation and cortisone injections are used in the treatment of knee pain and related conditions, they do come with certain risks and potential complications. It's important to be aware of these factors when considering either procedure for knee pain management.

Risks of Cortisone Injections

Cortisone injections are particularly effective in treating inflammatory arthritis, such as rheumatoid arthritis, and can be part of treatment for other conditions. However, repeated cortisone shots could potentially damage the cartilage within a joint. This is why doctors limit the number of cortisone shots into a joint based on different factors like the joint involved and the diagnosis.

Potential side effects of cortisone shots can include a temporary increase in blood sugar levels for diabetes patients and a short-term flare in pain, swelling, and irritation for up to two days after the injection.

According to Yale Medicine, cortisone injections can also have side effects such as facial flushing, headaches, fat necrosis, hypopigmentation at the injection site, and temporary elevations in blood sugar. There's also a risk of tendon injury with repeated injections. Infections can occur if proper sterile techniques are not followed during the injection process.

Potential Side Effects of Cortisone Injections
Temporary increase in blood sugar levels
Short-term flare in pain, swelling, irritation
Facial flushing
Headaches
Fat necrosis
Hypopigmentation at the injection site
Risk of tendon injury with repeated injections
Infections if proper sterile techniques are not followed

Potential Complications of Viscosupplementation

While viscosupplementation is generally considered safe, it is not without potential complications. Common side effects include localized pain, swelling, and stiffness at the injection site. In rare cases, patients may experience more serious complications such as infection, allergic reactions, or bleeding within the joint.

It's important to note that not all patients respond to viscosupplementation. The effectiveness of the treatment can vary depending on the severity of the knee condition and the individual patient's response. Therefore, it's crucial to discuss with a healthcare provider to understand the potential benefits and risks before undergoing viscosupplementation.

Potential Complications of Viscosupplementation
Localized pain, swelling, stiffness at the injection site
Infection
Allergic reactions
Bleeding within the joint

By understanding the potential safety concerns and side effects, patients can make more informed decisions about their knee pain management options. Always consult with a healthcare provider to discuss the most appropriate treatment option for individual needs.

Factors Influencing Treatment Choice

The choice between viscosupplementation and cortisone for knee pain management is influenced by several factors, including the nature and severity of the condition, the patient's overall health status, and the doctor's recommendation. This section discusses the indications for both treatments and the suitability of each for different patient groups.

Indications for Cortisone Injections

Cortisone injections are recommended for individuals with moderate-to-severe pain. They are particularly beneficial for those with inflammatory conditions like arthritis, tendonitis, bursitis, and trigger finger, where inflammation is the underlying issue. These injections can provide relief that can last from several days to over six months.

It's crucial to remember that while cortisone shots can efficiently manage inflammation and pain, they are more generalized treatments. They mainly address the symptoms of arthritis but do not directly tackle the root causes of the condition.

Suitability for Viscosupplementation

Viscosupplementation, on the other hand, is recommended for individuals with mild-to-moderate osteoarthritis. This treatment is most effective for patients with mild-to-moderate degeneration of the joint. It is not suggested for individuals who have severe, end-stage, or bone-on-bone arthritis.

During viscosupplementation, hyaluronic acid is supplemented or replaced in the joint to help reduce osteoarthritis symptoms, such as pain and swelling. This treatment doesn't provide immediate pain relief and is not an anti-inflammatory treatment. However, it might stimulate the body to produce more of its hyaluronic acid.

Unlike cortisone shots, viscosupplementation addresses the root causes of arthritis. By supplementing the joint with hyaluronic acid cushioning fluid, it compensates for lost cartilage, which can help increase joint function and motion in arthritic knees.

However, viscosupplementation is contraindicated in individuals with hypersensitivity to sodium hyaluronate preparations and those with known skin diseases or infections around and in the injection area.

The choice between viscosupplementation vs cortisone should be made in consultation with a healthcare provider, considering the condition's specifics, the patient's overall health, and the potential benefits and risks of each treatment.

Long-Term Considerations

When comparing viscosupplementation and cortisone injections for knee pain management, it's crucial to consider the long-term implications on joint function and alternative treatment options.

Impact on Joint Function

Viscosupplementation addresses the root causes of arthritis by supplementing the joint with hyaluronic acid cushioning fluid to compensate for lost cartilage. This can enhance joint function and motion in arthritic knees [2]. It's important to note that while viscosupplementation can provide pain relief for arthritis, lasting longer, around 6+ months compared to cortisone shots that may provide relief only for a few weeks or months.

Treatment Recommendations and Alternatives

Viscosupplementation is most effective for patients with mild-to-moderate degeneration of the joint. It's not suggested for individuals who have severe, end-stage, or bone-on-bone arthritis [2]. Evidence suggests that Hylan g-f20, a type of hyaluronic acid used in viscosupplementation, may be an effective interventional treatment for knee osteoarthritis and may delay the need for total knee replacement surgery [1].

As research continues, it's crucial for patients to discuss their unique circumstances, symptoms, and treatment goals with their healthcare provider. This will ensure a personalized and effective approach to managing knee pain, whether that means opting for viscosupplementation, cortisone injections, or exploring other alternatives.