An oil change for my knee?
Q: I have worked very hard to stay fit throughout my career. Lately, my left knee has started aching after heavy activity. After an examination and x-rays, my physician told me I have mild osteoarthritis. She outlined my treatment options which included viscosupplementation – something she said was like an oil change for my knee. What do you think of this as a treatment option for osteoarthritis? MWO Wearing
A: Dear MWO Wearing: Viscosupplementation refers to injecting joints with a lubricant called hyaluronic acid (HA). Your joints make several important substances and one of these is HA. HA reduces the friction in joints by coating surfaces that rub together. It also increases the shock absorbing properties of your joint fluids. Over time HA molecules breakdown and for some unknown reason osteoarthritic joints make less HA than non-osteoarthritic joints. Both of these changes make it easier for an affected joint to wear out even faster than normal.
Viscosupplementation has been available for over 30 years. Some of the more commonly used products include: Neovisc, Synvisc, Monovisc, Durolane and Suplasyn. These products vary in molecular weight, some are derived from rooster comb and some are synthetic, but they all work on the same principle – improving the quality of your joint fluids. The joints most commonly injected are the knee, hip, shoulder and ankle.
I have treated patients with HA injections for 20 years and find it works great in some people and it doesn’t seem to work in others. We currently have no screening tests to determine if a patient will respond to an HA injection but as a general rule the less arthritic your joint the more likely you will benefit. HA injections are not a permanent solution, they only last so long, however they can safely be given whenever your symptoms return – whether this is 6 months or 6 years after your last injection. HA injections can cause 2 potential side effects – 1. Infection – puncturing your skin with a sterile needle has a very small risk of infection; 2. Flair – some knees swell and hurt for several days after an HA injection.
The bottom line is that viscosupplementation is very safe and some people find it extremely helpful in terms of reducing or eliminating their pain and allowing them to enjoy an active lifestyle. While you may not be a car, with all the demands you have made on your body you might benefit from a regular oil change.
Dr. Darrell Menard MD Dip Sport Med
Dr. Darrell Menard OMM, CD, MD (former Physical Education Officer at RMC) now a Sport Medicine Physician