What is viscosupplementation?

Viscosupplementation is the injection of “joint fluid replacement” gel for the treatment of arthritis.  You may have previously heard them called “chicken comb” injection as some brands are made using that as the starting material. Sometimes we also call them “joint fluid replacement” injections.

The active ingredient in these injections is some form of hyaluronic acid which is used to help lubricate and cushion the knee.  

What is hyaluronic acid?

Hyaluronic acid is a protein in normal joint fluid that helps to cushion and lubricate the joint.  But when you have arthritis, the natural hyaluronic acid breaks down and becomes less effective.  Viscosupplementation is be used to help restore the cushioning and lubrication provided by natural hyaluronic acid.

What is viscosupplementation used for?

Viscosupplementation with hyaluronic acid is used to treat pain from knee arthritis.  It is frequently used after failure of other conservative methods, such as NSADIS, physical therapy, or steroid injections.

How is it given?

Viscosupplementation must be given by injection into the joint. A cold spray is used to numb the skin before the injection is given. We often perform these injections under ultrasound guidance in order to minimize pain and ensure proper injection into the joint space directly.

The brand of product determines how many injections are given.  Some involve only a single shot.  But others may require three injections.  Some of these can be extended to a series of five injections to improve effectiveness.

Is it covered by insurance?

When used for arthritis of the knee, viscosupplementation is usually covered by insurance.  Unfortunately, they are not covered for use in other joints such as hips or shoulders.

Some insurance companies allow us to provide this injection for your arthritic knee on the day your doctor orders it.  But other insurances require pre-authorization – in that case we handle all the paperwork for you but will have to set up a second appointment about a week later for the injection.

When does it start working? How long does it last?

Viscosupplementation takes longer to begin working that standard steroid injections.  You may start to see benefits as early as three weeks after injection.  And it can last for weeks or months.  It can be given every six months if needed but many patients see benefits longer than that.