With osteoarthritis, the cartilage surface of your joint wears away and the joint fluid breaks down. Injecting a special protein called Hyaluronic Acid into the knee can relieve pain and stiffness by lubricating and shock-absorbing the worn surfaces. This type of treatment is called “viscosupplementation”: it supplements the viscosity (slippery-ness) of your joint fluid. Currently, it’s only FDA-approved for knees.
The Hyaluronic Acid is a normal protein found in healthy cartilage, and looks like a clear gel. It is not a steroid. It does not cure arthritis. It doesn’t work for everyone. Most patients don’t have total pain relief, but do notice less soreness and stiffness for 6-12 months or more. The treatment can be repeated every 6 months if it has helped you. It is often a way to buy time until knee replacement surgery.
There are about 6 brands of this treatment on the market that all work about the same. Dr. Siegrist usually uses Synvisc.
- Synvisc—used for most our patients. Until 2009 was a series of 3 weekly injections, now given as 1 shot
- Euflexxa—3 weekly injections. Selected for patients who had allergic reaction to Synvisc in the past or patients who have Aetna insurance (their “preferred” brand)
- GelOne—given as 1 shot. Smaller volume than Synvisc (2cc vs 6cc).
I usually recommend one of these treatments for patients who:
- …do not feel locking or instability from loose flaps of worn cartilage inside the knee. This might need arthroscopic surgery first to clean out the joint. Some patients need the injection at 6+ weeks postop.
- …have knee pain that feels mostly like an aching, stiffness, or rubbing; not warm and swollen from inflammation. With inflammation, a steroid injection could be more useful.
- …had cortisone shots that don’t last at least 4-6 months, and there’s no locking or instability. If cortisone shots relieve your knee pain for 6 months or more, then it’s often OK to just stick with these.
This is only part of your treatment to relieve arthritic knee pain, the “icing on the cake.” You still have to manage your weight, do low-impact exercise daily and treat your knee with respect. Hopefully, you’ll be taking less pain medication, less often. If the shot doesn’t relieve enough pain, aching and stiffness in your arthritic knee, then it might be time for knee replacement surgery.
How much does it cost? How do you get it?
- We will schedule the injection appointment before you leave today, then get started on the paperwork.
- How it works: Depends on which drug is used, and the insurance covering your knee problem:
- Worker’s Comp needs no additional authorizations or out-of-pocket costs. This one’s easy.
- For most Synvisc patients: Our staff will contact your insurance company to find out your out-of-pocket costs, and then call you within a week. Then, you will tell us that it’s OK; payment is due at your injection appointment.
- For all Euflexxa patients, of if your insurance requires this for Synvisc: We’ll use a mail-order specialty pharmacy:
- Our staff will contact Accredo/Curascripts 1-866-759-1557 with your prescription information. Or, if your insurance demands a different pharmacy, we’ll go there.
- This pharmacy will check your insurance coverage and call you within a week about any out-of-pocket costs, and ask you to authorize them to ship the drug to our office. You pay the pharmacy for any drug-related costs, but may also have a co-pay at our office for the visit and/or the injection procedure.
- These drugs cost about $600-800 per knee. Insurance fees are based on a 5-digit code system.
- Synvisc CPT code J7325 OR Euflexxa CPT code J7323 (times 3)
- There is also the cost of the office visit (CPT 99213 or 99214) and injection procedure (CPT 20610).
- Insurance covers most of these costs, but every policy has different rules (and their rules change over time!)
After your injection:
On the day you receive the shot, and for the next 24-48 hours: avoid strenuous activity (no heavy lifting or standing/walking for more than about 1 hour. Don’t go do all of your Christmas shopping!) Apply an ice pack for 15 minutes every few hours. In 1-2 days you can resume unrestricted activity.
If your knee gets very painful and swollen within a few days of the shot, it could be an allergic reaction. It’s not dangerous, but can be painful. Call the office 585-271-4272 (or after hours 585-723-6566.) We may have you come in to have it checked/drained. This doesn’t happen very often.
If this was your first time getting this treatment, we’ll follow up in 4-6 weeks to check on your progress. Most patients notice relief by then. If the injection helped, and you have less aching and stiffness and it’s easier to move around, we’ll schedule a repeat dose in 6 months. At that point, we’ll have some options:
- If it’s still helping after 6 months, we’ll repeat the injection to maintain your pain relief and keep you on track. You can safely keep having these injections every 6 months as long as they help. You might choose to wait until it wears off to repeat it (not usually recommended; it could take 4-6 weeks for the new shot to kick in).
- If you had a lot of painful swelling after Synvisc (indicating an allergic reaction), we might switch to Euflexxa or Gel One in the future.
- If it helped, but wore off after 3-5 months, you could have a cortisone shot to quiet the knee and buy time until you’re due for another Visco shot. (Insurance won’t cover it sooner than every 6 months).
- If your knee starts to swell, lock up or give out (suggesting unstable flaps of torn cartilage inside), you might need arthroscopic surgery to clean out the joint. We’ll resume the treatment at 6 weeks postop.
- If it didn’t help at least 3-4 months, then it’s probably not worth repeating. It might be time for knee replacement surgery. Or, we could consider using one of the other brands.