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Hyaluronic Acid Injections - Knees

post #1 of 16
Thread Starter 

Have you had them?  If so, what was your experience?  Could you feel a difference when skiing? 

 

Thanks!

post #2 of 16

I have not had one but I have had dozens of patients who have had them. They work well and last for about 1 year. They are a stop-gap for knee replacement only, tho, and not a cure. I imagine your knee will feel about the same as it did prior to arthritis setting in with your skiing. If someone has recommended one, he (or she) is thinking you will need a knee replacement in about a year or two. There's a new procedure that just replaces the medial compartment. It doesn't require as much bone loss to perform, so you may want to research that, too

post #3 of 16
Thread Starter 

Thanks for your response.  I am hoping to avoid any knee surgery as long as possible, but when the time comes I'll certainly look into the partial replacement.  Someone I know is considering it, so I hope to get some first hand feedback. 

post #4 of 16

Hello, I can give you some more details regarding your question. I am a physician who runs a knee program for osteoarthritis. My program consists of hyalgan injections and physical therapy for the knees. I perform hundreds of knee injections every month and document the results of each patient. The key determining factor is the severity of the arthritis as seen on x-rays. If you still have some space and its NOT bone on bone then you have an 80% chance of achieving greater than 50% pain reduction for 6 months to 2 years. Average is about 1 year. If you do have severe bone on bone arthritis then your chance of success is much much less (30%) which could just be a placebo effect. The injections are safe and there are no side effects. If you do get a good response then I would hold off on knee replacements for as long as possible. Once you get a replacement there is no going back. Meaning, if you continue to have pain following the surgery (and many patients do), there are no further effective treatments other than pain meds. Also, skiing will put a significant stress on the knee replacement and it could wear out sooner than ten years. A  2nd replacement is very difficult and complications can occur. just some food for thought.

agreen

post #5 of 16

I've been getting them for 5 years now. One round of Synvisc which I didn't feel made much of a difference. I've had 3 rounds (in the middle of the fourth) of Suppartz and notice a difference right away. I get them every fall to help with pain during ski season. I still have pain, and grinding feelings, etc, but it's definitely an improvement after the injections. They last about 6-8 months for me. It's worth a shot to try them to see if they help.

post #6 of 16

If any of you guys have lousy health insurance like I do, Synvisc-One is $329 from Northwest Pharmacy in Canada vs. $1200 even at Costco in the States

post #7 of 16
Quote:
Originally Posted by UberGaper View Post

If any of you guys have lousy health insurance like I do, Synvisc-One is $329 from Northwest Pharmacy in Canada vs. $1200 even at Costco in the States


 Who injects it for you?  Improper placement would negate any beneficial effects?  Some places even use ultra sound to insure they get it right.

 

I've had three series of Othovisc injections in my knee.  It helps me? 

 

With my PPO discount it's about $250/injection or $750/series.   If my deductible is covered, it's gratis.

post #8 of 16
Do they help with the pain from a small meniscus tear?
post #9 of 16
Quote:
Originally Posted by agreen View Post

Hello, I can give you some more details regarding your question. I am a physician who runs a knee program for osteoarthritis.

 

 

Do you have any details on injections in the hip?    I was told that orthovisc is not approved in the hip, but that it may help?

 

 

 

Skimangojazz:

 

Agreen would be much more qualified to answer.  I have severe OA/DJD.

post #10 of 16

You need to pay the orthopedist for the joint injection. 

post #11 of 16
Quote:
Originally Posted by SHREDHEAD View Post


 Who injects it for you?  Improper placement would negate any beneficial effects?  Some places even use ultra sound to insure they get it right.

 

I've had three series of Othovisc injections in my knee.  It helps me? 

 

With my PPO discount it's about $250/injection or $750/series.   If my deductible is covered, it's gratis.

The Synvisc-One is one shot of 6ml vs 3X2ml of regular Synvisc

post #12 of 16
Quote:
Originally Posted by agreen View Post

Hello, I can give you some more details regarding your question. I am a physician who runs a knee program for osteoarthritis. My program consists of hyalgan injections and physical therapy for the knees. I perform hundreds of knee injections every month and document the results of each patient. The key determining factor is the severity of the arthritis as seen on x-rays. If you still have some space and its NOT bone on bone then you have an 80% chance of achieving greater than 50% pain reduction for 6 months to 2 years. Average is about 1 year. If you do have severe bone on bone arthritis then your chance of success is much much less (30%) which could just be a placebo effect. The injections are safe and there are no side effects. If you do get a good response then I would hold off on knee replacements for as long as possible. Once you get a replacement there is no going back. Meaning, if you continue to have pain following the surgery (and many patients do), there are no further effective treatments other than pain meds. Also, skiing will put a significant stress on the knee replacement and it could wear out sooner than ten years. A  2nd replacement is very difficult and complications can occur. just some food for thought.

agreen

I'm sorry to say that but there is a possibility of side effect from Synvisc! The first time I was injected, it was ok but the second time, I had a big reaction and my doc said it was like an allergic reaction. She had to inject me with an anti-inflammatory and it was the last time I tried... but Suppartz? Is it the same?

post #13 of 16

I had a nice long talk with a doctor last night regarding Stem Cells, PRP and Hyaluronic Acid injections.  Her opinion was that the more Hyaluronic Acid injections you have, the less effective they become?  I would say that has also been my experience as well.

post #14 of 16

I don't think there's a lot of conclusive evidence for the injections.  It is the bodys response to the injection itself, and not necessarily what is injected. Some tests showed a healing response with saline alone.

 

Now here's an interesting small but potentially significant study involving tennis elbow showing that over time, Autologous ( a simple injection of the patients own blood to the injury site) showed better long term healing than cortisone alone.

 

http://www.bjr.boneandjoint.org.uk/content/1/8/192.full


Edited by Finndog - 10/26/12 at 7:32am
post #15 of 16

Sorry, I didnt see the responses til just now. Bone on bone in the hip will likely need hip replacement surgery. Its a difficult injection but commonly done with either x-ray guidance or ultrasound guidance and so far is not covered by insurance. The shoulder will be next to get FDA approved then the hip.

 

For meniscus tears: it depends what kind of tear. If its a chronic degenerative tear from arthritis (menscus tears are very commonly seen in the setting of mod to severe arthritis) then the shots can help. If its an acute tear ie. from a skiing fall then the shots wont help typically.

 

Synvisc and synvisc one are synthetic and have a approx 10% allergy response. Hyalgan has virtually no allergy response unless you are allergic to eggs. not sure about Supartz.

 

The latest studies show the injections (at least Hyalgan) can become more effective each series for 3 years. They havent been studied past that and my thought would be they then become less effective probably due to advancing disease and not tolerance to the medication as seen with cortisone shots.

 

Finndog: there is a ton of evidence supporting this type of injection for mild to mod arthritis. Not good for severe arthritis (bone to bone). otherwise it would not be FDA approved and medicare would not cover it. they are pretty expensive but knee replacements are much more expensive and need long rehab after and have lots of complications ie. DVTs which can require prolonged hospital stays and much higher cost. thats prob why medicare covers the injections.

 

Agreen

post #16 of 16

Just placed a call to my doctor concerning the benefit of HA injection at this time . He had recomended them after my second knee surgery in 2007. At that time I said I would wait on getting the injection to see how the knee progressed. Last MRI in 2011 said ACL grade 2 sprain and degenerative change, PCL is buckled but intact, medial meniscal posterior horn showed degenerative change and focal tear . medial meniscal body showed extrusion. quadriceps and patella tendon are grossly normal. The MCL showed grade 2 sprain. There is moderate patella femoral joint effusion and mild lateral tilting of patella. There is a large sized Bakers cyst.

 

He believes that at this time the HA injection wont help and I should proceed no with the 3rd operation to fix 5 of the 7 problems in the last MRI and then in the future have the knee replaced. I am currently 53 years of age and trying to hold off on another surgery ( just had back surgery 1/8/14 )

Any feed back will be a help

TY, 

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