Will only surgery help my aching and arthritic knee?

How Can We Help?

Evan J. Zahner, MDby Evan J. Zahner, MD

Pain is a common complaint when someone suffers from knee osteoarthritis. X-rays may show significant arthritis and many resign themselves to putting up with the pain until they are ready for surgery. It may surprise you to know that orthopedic surgeons will often use surgery as a last resort. They want to try everything possible to delay surgery until they are confident that surgery is the best alternative. You may have tried ibuprofen, non steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, cortisone injections, and physical therapy and been disappointed with only temporary results. Is there anything else that can help?

For some, the answer may be found in viscosupplementation. Think of “visco” as meaning liquid or lubricant and the more familiar “supplementation” meaning in addition to. So, viscosupplementation treatments add a lubricant liquid to the knee. Recent advances in science have allowed for accurate reproduction of the fluid that is inside the knee joint. This fluid, referred to as synovial fluid, often becomes diminished in an arthritic knee. Viscosupplementation injections, such as Synvisc or Euflexxa, can be given to patients to restore the fluid within the knee and temporarily relieve pain.

The injection is a man made version of the substance that makes up the majority of the synovial fluid in the joint. It is called hyaluronic acid. In some circumstances, as is done with Euflexxa, the injections are given as a series of three injections; one injection per month. At Agility, we most often use a product called Synvisc One. This product allows patients to get the entire three month regimen of the treatment in a single dose injection. Abraham Shurland, MD, an orthopedic surgeon with Agility, describes, “We have found patients are provided with about 6 months relief with a Synvisc One injection”. He continues, “The convenience for the patient of not having to come back for multiple injections combined with the clinical outcomes has been advantageous”.

The process of receiving an injection is straight forward and is completed in just a few minutes. First, the area around the knee is cleaned with an iodine solution. To reduce pain, a local anesthetic is often used just prior to the injection. Then, the needle is positioned properly in the knee joint and some of the synovial fluid is removed. Lastly, the hyaluronic acid is injected directly into the knee joint. The pain relieving benefit of the injection does not start immediately. As a matter of fact, patients may notice an initial period of increased pain and warmth in the knee. An ice pack can help get you through the first 48 hours after the injection. It is during this time that you are asked to avoid prolonged standing, jogging, or even heavy lifting.

Gradually, you should come to feel less pain and tolerate a higher level of activity. Generally, the benefits are significant but temporary. The long term plan to address your knee osteoarthritis is something we are happy to discuss with you.

To learn more about Viscosupplementation, Synvisc, and Euflexxa injections, listen to a brief Podcast that will provide further information to help you decide if this type of procedure is right for you.