I receive a common question from patients with arthritis. I think it’s worth answering and discussing the pros and cons.

Do Synvisc and similar injections help pain from arthritis?

Synvisc is an injectable medication that falls in a category called viscosupplementation. There are several such injections – like Supartz, Euflexxa, and others – in this category.

These treatments are aimed at relieving pain from osteoarthritis. Other osteoarthritis treatments include activity modification, anti-inflammatory medications, physical therapy, and cortisone injections. Surgery is rarely used to treat OA until the cartilage has broken down to the point that the joint essentially has bone-on-bone contact. Then knee replacement can be an effective treatment.

Cortisone shots for knee arthritis

Cortisone shots have been used to improve osteoarthritis pain for decades. The steroid provides pain relief by decreasing inflammation in the diseased joint. Like the other treatments for OA, it does not rebuild damaged articular cartilage. In fact, multiple injections over short periods of time theoretically increase the breakdown of articular cartilage.

Cartilage damage in the knee
Note the frayed articular cartilage on the end of the femur (red arrow). This is the appearance of cartilage in more advanced arthritis.

Viscosupplementation injections

Viscosupplementation treatments are a series of injections (one per week for 3 or 5 weeks) designed to relieve pain from osteoarthritis. They are synthesized in the laboratory out of the combs of roosters. Each is chemically engineered to replicate hyaluronic acid, one of the main components of a joint’s synovial fluid.

Despite tremendous enthusiasm when they arrived, scientific studies have always shown mixed and often unimpressive results.

On the other hand, many of us in orthopaedic surgery occasionally use them for patients with osteoarthritis of the knee. It seems like a decent percentage of patients get some relief. It seems to take about six to eight weeks after the third (or fifth) injection before patients realize how much of a benefit they will receive.

Fortunately viscosupplementation injections have few side effects. Almost everyone can receive them, except patients with gout and those allergic to eggs. Other than a small risk of infection with injections into a joint, which exists with cortisone as well, there are no significant medical side effects. The biggest risk, and one which patients must understand, is that the injections might not work.

Reducing pain from arthritis

The major problem with osteoarthritis is that orthopaedic surgeons have no way to restore pristine articular cartilage. All of the treatments for osteoarthritis try to reduce symptoms, such as pain and swelling, and improve function. None of them, including viscosupplementation, make cartilage new again. Maybe platelet-rich plasma will prove to do that, but much more research in needed.

In summary, viscosupplementation is an option for osteoarthritis. In many patients, they might provide pain relief. How much relief, and for how long (if at all), is difficult to predict.

Man with knee pain from arthritis

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