Visco-supplementation for Arthritis of the Knee

Osteoarthritis in the knee is one of the leading causes of disability for individuals in the United States. Osteoarthritis causes the protective cartilage on the ends of your bones to wear down over time. The condition develops slowly, becoming more painful as it does so. Visco-supplemntation is an option for treating the pain and swelling of the affected joint.


During this procedure, hyaluronic acid is injected into the knee joint. This acid is naturally occuring, found in the synovial fluid around joints. It behaves as a lubricant to allow bones to move smoothly over each other. It also acts as a shock absorber for joint loads. 

Patients who have osteoarthritis have a lower concentration of this important fluid in their joints. This means that they have less protection against joint friction and impact like weight-bearing activities. It is believed that this lack of protection can actually accelerate the joint degeneration process. The goal of using these injections is to reduce pain in the knee joint, improve the joint’s function by reducing friction and inflammation, and maybe slow the progression of osteoarthritis. 

Causes of Visco-supplementation 

While there are no cures for osteoarthritis, there are a variety of treatment options to help individuals manage their pain and stay active. In osteoarthritis’ early stages, treatment mainly consists of nonsurgical methods. These include modifying activities, weight loss, pain relievers, physical therapy, and corticosteroid injections. 

When these options do not curb your pain enough to be able to return to your normal activities, viscosupplementation may be used. It is also a common treatment for people who are not eligible for knee surgery, want to postpone the surgery, or simply do not want surgery. Visco-supplementation is generally recommended for those 65 years and under who have mild to moderate osteoarthritis.

Symptoms of Osteoarthritis

People suffering from osteoarthritis who might benefit from this procedure may be experiencing some of these symptoms:

  • Pain either during or after movement
  • Stiffness in the joint after waking up or being inactive
  • Tenderness to the touch when applying just a light pressure
  • Loss of the ability to move the joint through its full range of motion
  • A grating sensation when using the joint, sometimes creating a popping or crackling noise
  • Bone spurs that feel like hard lumps forming around the joint
  • Swelling due to soft tissue inflammation near the joint

The Procedure

First, your doctor will clean the area where the injection will be made. Then they will inject a local anesthetic into the area so you won’t feel any discomfort during the procedure.

The doctor will guide a needle into the space within the knee joint. They may use a fluoroscope, an x-ray that shows moving images, to verify the placement of the needle. If the joint has excess fluid in it, your doctor might remove some of that fluid before beginning the injection. Then, once the needle is in the correct position, they will inject the hyaluronic acid.  

When all of the acid is injected, the doctor will remove the needle and bandage the site. 

After the Procedure

Sometimes one injection may be enough to feel relief, but typically, three to five injections will be needed. These injections are spaced one week apart. A lot of visco-supplementation patients report feeling pain relief during the 3 to 5 week course of the injections. However, the greatest pain relief typically occurs 8 to 12 weeks after the treatment begins. How long the pain relief lasts varies, but some have reported that the benefits last for more than 6 months after the injections. 

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