Viscosupplementation has become increasingly more popular as new “devices” (preparations) have become available. Viscosupplements are biologic synovial prosthetics. They bind to the joint surface and lubricate and cushion your knee joint. They are designed for Degenerative Joint Disease (DJD), so called osteoarthritis. They represent another treatment option for the pain and swelling of chronic DJD. For patients who wish to consider a non-surgical option or who are trying to postpone an inevitable Total Knee Arthroplasty (TKA), viscosupplementation may give significant but temporary relief of pain and swelling.
While non-steroidal anti-inflammatory medications can potentially lead to stomach or intestinal problems, and especially with the controversies over some of the recent so called Cox-2 inhibitors, the viscosupplements have no such side effects or risks. Similarly cardiac disease or other systemic problems do not tend to be a contraindication. The only real contraindication is an allergy to chicken, eggs or foul. There is a small chance of reaction to the fluid itself as a result of hypersensitivity which may be associated with any of the viscosupplements.
There are several viscosupplements on the market today. They are all a type of preparation of hyaluronan or sodium hyaluronate. Some require more injections, some have higher molecular weights which means they are thicker and tend to be more efficient and some have longer lasting effects. The grafts below compares some of the various products on the market.
Based on the information available, Dr. Berman, Medical Director of the Joint Preservation Center uses Synvisc-One (Genzyme Corporation) routinely. Synvisc-One has been found to improve pain and swelling in Osteoarthritis. Synvisc-One has the highest molecular weight of all the viscosupplements. Higher molecular weight preparations have been shown to provide improved pain control compared to lower molecular weight preparations. It is the only high molecular weight preparation which is cross-linked with multiple derivatives of hyaluronan. Further, it requires only 1 injection to give the maximum relief available. Patients can have relief for about 6 months, however, results are highly variable and some patients have relief of symptoms for as much as 9 to occasionally 12 months.