Viscosupplementation Injections (aka gel injections)
Arthritis is a condition that causes intense pain and can be debilitating. With appropriate pain management and treatment, the pain it inflicts doesn’t have to be all-consuming. As New York, NY’s premier pain management practice, Downtown Pain Physicians offers innovative pain treatments designed to help provide lasting pain relief.
Viscosupplementation injections are an option for patients who suffer from osteoarthritis. When more conservative treatments such as over-the-counter medications and corticosteroid injections haven’t provided the pain relief that patients expect, this treatment may be a solution. Pain specialist Dr. Raval starts evaluating each patient based on the pain level, medical history, and previous procedures. The team at our practice uses state-of-the-art testing to pinpoint the source of pain to find a lasting treatment.
Dr. Raval is very kind and explains everything in layman’s terms, which is super helpful. Thanks so much, guys! 🙂
“PLEASANT AND PROFESSIONAL”
Best doctor visit I ever had. Staff was pleasant and the doctor was very pleasant and professional. Took his time and answered all my questions.
What is Osteoarthritis?
Osteoarthritis (OA) is a chronic joint condition that impacts more than 30 million people in the United States. While it is most common in older adults, it can occur at any age. OA is the result of joint damage that occurs over time. This is why it tends to present in older people more often because they have had more wear and tear on their joints. OA is a common reason why patients try gel injection for joints.
Joint damage can occur as a result of:
- Poor posture
- Torn cartilage
- Joint malformation
- Ligament injuries
The joint damage caused by OA occurs due to lack of cartilage. Cartilage is a tough substance that is flexible. It protects the ends of the bones in a joint and allows them to move against each other. This means that when the cartilage breaks down, the surfaces of the bone become rough and pitted, which causes pain. It also results in irritation in the surrounding tissues. Unlike other types of tissue in the body, cartilage can’t heal itself because it has no blood vessels.
Once it breaks down completely, the bones start to rub on each other directly which causes intense pain, inflammation, stiffness, and tenderness. It can occur in any joint in the body but some of the most common are:
OA progresses through 5 stages between 0 and 4. 0 represents normal joints while 4 is the most severe OA that someone can have. Stabilizing OA is important to help make sure patients don’t reach this point.
What is Viscosupplementation?
Viscosupplementation injections, also known as gel shots are commonly used as a way of treating OA or another type of arthritis. When patients receive orthopedic gel shots, they have hyaluronic acid injected into their joints. It’s a thick fluid, like synovial fluid that is intended to help reduce pain in arthritic joints, most commonly the knee joint. Patients usually have viscosupplements for knee pain if they’ve tried other treatments and those treatments have been unsuccessful in achieving pain relief.
When is Viscosupplementation Considered as a Treatment Option
Viscosupplementation is considered after other types of treatment have been tried or as a part of a more comprehensive treatment plan. Patients generally receive 3 to 5 injections separated by a week.
What to Know about Synovial Fluid
Synovial fluid is an important part of joint health. It is the part that acts as a cushion and absorbs shock for the cartilage and bone. Lack of this fluid helps contribute to pain and discomfort that patients feel as a result of OA or other conditions. Hyaluronic acid is one of the components in synovial fluid. When a joint is healthy, the fluid gets broken down and replaced. This process slows down in joints affected by OA which means the fluid breaks down and is replaced less frequently.
This results in the joint receiving more friction and impact than it would normally be protected from. Viscosupplementation helps to supplement this fluid using artificial hyaluronic acid. The point of using a synthetic hyaluronic acid viscosupplementation is to lubricate the joint to improve pain and movement.
Comparing the Differences Between Gel Shots and Corticosteroids
Steroid injections are another type of stronger treatment to help improve joint function. They typically contain a corticosteroid medication and a local anesthetic. They are more commonly known as cortisone shots. They are injected in the same joint space as steroid injections and will provide immediate pain relief for the patient and the recovery time is usually less.
These injections do have their downsides. Since they do cause blood sugar to rise, steroid injections need to be used cautiously with diabetics. They also come with the risk of adverse effects if they are used for a long time. Patients may also have an allergic reaction to them.
Gel shots, by contrast, are viscosupplementation with hyaluronate which acts as the synovial fluid that helps your joints to move. This reduces pain and improves movement without the same risks as a steroid injection.
Why Choose Viscosupplementation Injections?
Patients often turn to viscosupplementation injections or gel shots for the knee after trying other treatments like over-the-counter pain medications or steroid injections. Gel shots may be used in combination with other treatments to help reduce stiffness, pain, and swelling for people with mild or moderate arthritis. Sometimes patients may want to get this type of treatment as a way of helping them delay surgery on their joints.
Hyaluronic acid injections are most commonly used in the knee joints but may be able to be used in another location. Viscosupplementation is not the correct treatment for all types of arthritis, which is why the doctor will consider your medical history, pain, and previous procedures carefully before making a recommendation for treatment of any kind.
Who is a Candidate for Viscosupplementation?
Viscosupplementation is a treatment that is for patients who have mild to moderate osteoarthritis, commonly of the knee. But it may be used in other joints if that is deemed to be the appropriate course of treatment. It is an effective treatment that is minimally invasive which is why it may be one part of a comprehensive treatment plan that includes other things like physical therapy, exercise, other potential treatments depending on the specific case.
Gel shots for knee joints can be obtained by patients every six months if they find the treatment to be beneficial. Ongoing treatment can help reduce the symptoms that they feel.
It is important to note that some viscosupplementation medications are created using sterilized and processed rooster combs. So if the patient is allergic to poultry products or poultry itself, this version cannot be used. But other synthetic variants can be used for patients with these allergies.
The injections are not appropriate for patients who:
- Have an allergy to hyaluronate products
- Are pregnant or nursing
- Are a child or adolescent
- Have an infection, bacterial or otherwise in or around the area of the injection
Deciding to Have a Viscosupplementation Injection
The decision to choose a viscosupplementation injection is a joint decision made by you and the doctor you work with at our practice. Make sure to ask any and all questions you might have in order to fully understand the procedure and what to expect from the injections.
Once you decide to go with viscosupplementation therapy treatment, you will come into the office once per week for 3 to 5 weeks to receive your treatment.
Preparing for a Viscosupplementation Injection
Unlike other types of pain procedures, this type of injection does not require a lot of preparation. You can eat or drink the same way you normally would on the day of the appointment. Make sure to tell the doctor if you are experiencing new symptoms or signs of an infection like a fever.
The Injection Procedure
Depending on the pharmaceutical brand of injection medication used, you may have multiple injections or one injection scheduled once per week. It typically takes no more than a few minutes to complete.
For a knee injection, the patient will lie down with a straight leg or upright with their knee bent. The position depends completely on the doctor’s preference and how he wants to inject the knee capsule.
The knee will be wiped down with a disinfectant like alcohol or iodine. After this is done you’ll be instructed to relax your leg muscles to make the injection less painful and successful. A local anesthetic will be applied by the doctor to numb the area. The doctor may also remove or aspirate any excess fluid from the knee if’s swollen.
To help deliver the gel shot into the knee joint directly, the doctor may choose to use an ultrasound to correctly locate where to inject the medicine using a new sterile syringe. After the procedure, the injection site is cleaned again and bandaged. You’ll be asked to bend and straighten the knee a few times to help spread the medication in the joint.
Post Procedure Care and Expectations
After the injection is complete, you’ll be told for a period of 12 to 24 hours. Low-impact activities like slow start walks are encouraged. Avoid heavy activities like running or carrying heavy loads during this time period. Expect to start experiencing results 3 to 4 weeks after the first injection.
You may have physical therapy and follow-up exercises like single-leg flutters after your injection. This helps to maintain muscle strength and increase it around the knee joint.
Side Effects and Risks of Viscosupplementation Injections
As with any painful procedure, there are side effects that can result from the injections. Most people do not have any issues with the injections. A small portion of patients do. The most common gel shots for knee side effects are heat, pain, swelling, or redness at the injection site. You may experience rash and itching or bruise around the joint. Fluid accumulation around the joint is also another side effect. These symptoms are usually mild and do not last for all that long. Similar to steroid injections, there is a risk of bleeding or infections. Bursitis is also a possible side effect.
You may also experience pseudo-septic arthritic reactions, The complication is rare, but it can occur within 3 days of the injection. If this happens, it can be treated with steroids or NSAIDs, or non-steroidal anti-inflammatory drugs.
Talk with your doctor about what to expect if you choose a viscosupplementation injection treatment. There are other treatments like physical therapy, heat, and cold, use of over-the-counter pain relievers, a cane, or other treatments such as steroid injections.
Data and Statistics
In a series of controlled trials, hyaluronic acid was shown to have a modern effect on symptoms, and it also delayed knee replacement surgery.
A 5-year study with patients treated for knee OA showed that treatment worked for 71% of participants had effective treatment one year out. 26 of 82 knees study received surgery 5 years after treatment.
Over a 30-month period 53 cases of knee OA were treated and 88% of participants improved their mobility.
Three patients with s tage III and IV OA were treated with viscosupplementation and all of them received pain relief within the first 3 days of injection.
Frequently Asked Questions
When Will I Experience Pain Relief from a Viscosupplementation Injection?
Patients most commonly experience relief from gel shots for knee pain within the 3 to 5-week window of treatment. Relief continues to increase 8 to 12 weeks after the start of the treatment. Some patients may experience benefits from this injection up to 6 months following their injection.
How Effective are Viscosupplementation Injections?
Viscosupplementation injections are effective, particularly for patients who are experiencing mild to moderate OA. Patients treated typically feel pain relief 3 to 5 weeks after their injection and will feel an even greater sense of pain relief 8 to 12 weeks after their treatment. Most insurance companies let their patients repeat their injections after 6 months. You may be asked to try a series of viscosupplementation injections rather than a single dose. Receiving a series of injections is common.
What are the Risks of a Viscosupplementation Injection?
The most common risks or side effects of gel shots are a flare-up of your arthritis right after the injection. It may cause temporary pain and swelling but can be treated with NSAIDs or steroids. Other risks and side effects you may experience include:
- Allergic reaction
- Pain at the injection site
To avoid infection, it’s recommended that you wait to receive the injection if you already have an active injection. It’s also important to remember that this treatment may or may not address all the symptoms you’re feeling. Your risk for complications also varies depending on your medical conditions and how often and where your injections are being given. An ice pack may relieve some of the common symptoms.
What Will Happen After the Injection?
You will be able to go home on the same day. Ask the doctor if you have permission to drive. For 48 hours after, avoid doing things like excessive walking, lifting heavy weights, jogging, or standing for long periods. It is important to keep all future appointments for your injections because they have an impact on the overall effectiveness of the treatment.
What if the Injections Don’t Work?
If the injections don’t work, talk with your doctor about other types of treatments such as steroid injections. You may also consider using viscosupplementation injections as part of a more comprehensive treatment plan that includes other treatments and things like exercise and physical therapy. Joint surgery is another option if other types of treatment don’t work.
Treating Your OA with Viscosupplementation in New York, NY
Living with arthritis like OA is a daily struggle in pain management. Downtown Pain Physicians seeks to help patients in New York, NY struggling to find relief from arthritis such as OA with viscosupplementation. It is a non-invasive procedure that provides proven pain relief from the symptoms of OA for many patients.
Also, viscosupplementation can be used in combination with other types of treatments like physical therapy, medications, and steroid injections. This treatment has also been shown to delay the need for joint surgery. If you’re ready to find a treatment to relieve your pain, call our office at 212-404-8070 to schedule your consultation appointment.
The information on this website is to provide general information. In no way does any of the information provided reflect definitive treatment advice. It is essential to consult a best-in-class pain management specialist in New York regarding ANY questions or issues. A thorough evaluation should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call your pain doctor to schedule a consultation.
Dr. Raj Raval, M.D.
- Board Certified
- Interventional Pain & Musculoskeletal Medicine Specialist
Education & training
- SUNY Downstate PMR Residency
- Rutgers University Fellowship