Viscosupplementation

[OIFDan]

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[greenberetTFS]

Does anyone have any experience with these injections? I was just recommended a series of injections in the cartilage both of my knees. I have read about the injections online, but am somewhat curious if there might be anyone in this forum that has had personal experience with them. From my understanding they simply juice up the knee cartilage with little or no side effects, and that the shots can last up to a couple of years. Any personal experience is appreciated.
-Dan

OIFDan,

Belated response to your post....I've just noticed your request for some feed back on visco supplementation. I was offered the same injections,however I have had "negative" feed back on it from several guys who told me it didn't work for them. This is a late response, so you may have had the shots already. If you've had them I'm interested in what, if any, help it's given you. :confused:

GB TFS :munchin

[Boomer-61]

I'm a practicing Ortho PA of 20 years. I've been injecting folks for about four years now with either Syncisc or Supartz. Synvisc is a three injection series and Supartz recommends 5. If you have no sensativities to poultry you are good to go. It's extracted from the rooster comb. In my experience, if you have mild to moderate (your Ortho Doc can tell you this) arthritis there is about a 60% chance of showing signs of improvement. The lasting effects are unpredictable, some go three months, some a year. It has some mild initial antiinflammatory effect. The theory is that by increasing the viscosity of the joint fluid it will enhance lubrication, decreasing friction and the inflammatory response. The cost is generally about $600 for the three Synvisc injections plus the cost of having them administered. In my mind, it's cheaper than surgery.

[greenberetTFS]

I'm a practicing Ortho PA of 20 years. I've been injecting folks for about four years now with either Syncisc or Supartz. Synvisc is a three injection series and Supartz recommends 5. If you have no sensativities to poultry you are good to go. It's extracted from the rooster comb. In my experience, if you have mild to moderate (your Ortho Doc can tell you this) arthritis there is about a 60% chance of showing signs of improvement. The lasting effects are unpredictable, some go three months, some a year. It has some mild initial antiinflammatory effect. The theory is that by increasing the viscosity of the joint fluid it will enhance lubrication, decreasing friction and the inflammatory response. The cost is generally about $600 for the three Synvisc injections plus the cost of having them administered. In my mind, it's cheaper than surgery.

Boomer-61,

Thank you for your feedback...Have you ever used Hyaluronate? I read it's the latest synthetic joint fluid.

GB TFS :confused:

[Boomer-61]

TFS,
Hyaluronate is Hyalgon (sp) I believe, which is Hyaluronate sodium which is essentially the same as Synvisc (hyaluronic acid) so I gotta believe the results would be the same.
Boomer

[MVS2]

I used Joint Soother for some knee problems - worked well (less pain and less crunchy/scraping feeling) after taking it regularly for a few weeks.

[greenberetTFS]

I used Joint Soother for some knee problems - worked well (less pain and less crunchy/scraping feeling) after taking it regularly for a few weeks.

MVS2,

Is this an OTC product ?

GB TFS

[MVS2]

MVS2,

Is this an OTC product ?

GB TFS


Yeah - here's a link to the company's website

http://www.vitaminworld.com/pages/Categories.asp?xs=4350C7BF7E08429F9BD36C31B911B8F2&CID=31

[Red Flag 1]

I'm a practicing Ortho PA of 20 years. I've been injecting folks for about four years now with either Syncisc or Supartz. Synvisc is a three injection series and Supartz recommends 5. If you have no sensativities to poultry you are good to go. It's extracted from the rooster comb. In my experience, if you have mild to moderate (your Ortho Doc can tell you this) arthritis there is about a 60% chance of showing signs of improvement. The lasting effects are unpredictable, some go three months, some a year. It has some mild initial antiinflammatory effect. The theory is that by increasing the viscosity of the joint fluid it will enhance lubrication, decreasing friction and the inflammatory response. The cost is generally about $600 for the three Synvisc injections plus the cost of having them administered. In my mind, it's cheaper than surgery.

Boomer,

Is this a parenteral Glucossamine?

RF 1

[shr7]

RF1

Sodium hyaluronate. It works on the synovial fluid, increasing viscosity/protection of the joint. It is injected intra-articularly. It's also used in eye drops to protect tissues during certain eye surgeries. (I don't know anything more about that.) It is supposed to be decently effective, similar to intra-articular steroid therapy. It therefore has a good steroid/NSAID sparing effect. I don't know a whole lot about it, I will leave the rest to those who actually have some experience with the drug.

SR

[Red Flag 1]

RF1

Sodium hyaluronate. It works on the synovial fluid, increasing viscosity/protection of the joint. It is injected intra-articularly. It's also used in eye drops to protect tissues during certain eye surgeries. (I don't know anything more about that.) It is supposed to be decently effective, similar to intra-articular steroid therapy. It therefore has a good steroid/NSAID sparing effect. I don't know a whole lot about it, I will leave the rest to those who actually have some experience with the drug.

SR

Thanks.

That is what I thought. This then has little effect, if any, on the articular surfaces.

There is an injectable Glucossamine that the Vets are using. I can say that because we just finished a series of six on my Lab, she blew out her knee.

Glucossamine is a dietary supplement. As such, not well regulated by the FDA. The problem with OTC Glocossamine is what portion of the oral dose actually winds up in the joint space. If there is a human injectable Glucossamine preperation, I have not heard of it.


RF 1

[MVS2]

RF1

Sodium hyaluronate. It works on the synovial fluid, increasing viscosity/protection of the joint. It is injected intra-articularly. It's also used in eye drops to protect tissues during certain eye surgeries. (I don't know anything more about that.) It is supposed to be decently effective, similar to intra-articular steroid therapy. It therefore has a good steroid/NSAID sparing effect. I don't know a whole lot about it, I will leave the rest to those who actually have some experience with the drug.

SR


Would that be similar to hyaluronic acid?

[shr7]

Would that be similar to hyaluronic acid?

Yes, sodium hyaluronate is the conjugate base of hyaluronic acid. I'm assuming some sort of solubility or stability issue. However, for all intensive purposes, we are talking about the same thing.

RF 1 -
I have not heard of nor seen any type of injectable glucosamine for humans. I have seen a few instances of IM, IV, or IA injection in studies, but I don't know of any commercial preparation. And you hit upon an interesting point about the availability and distribution of oral glucosamine. To bad no drug company would ever risk it's profits to try to prove their drug actually worked in an objective study.

[Boomer-61]

RF1,
As above, no injectable preparations of Glucosamine/Chondroitin sulfate that I am aware of. I posted a reply to a thread about Cosamin DS and our experience with it.
What I see with these products, Synvisc, cosamin, is that they are no cure for arthritis. I think of them as joint nutrition suppliments whether it be by mouth or injection. If it keeps you out of the operating room then it's done its job. If your joints are bad enough, they just delay the inevitable.
I think there is a lot of research yet to be done with these products. But like vitamins it is hard to select out who they actually help or prevent arthritis in versus who just has good genes.
So for now, I tell my patients to stay as fit as possible, in ways that do not affect their aching joints and that's usually in a pool or with non-impact loading ways. Stay as close to their ideal body weight as possible. Avoid activities that exacerbate their symptoms. Use the products if they help. Use a trekking pole if they don't.
Boomer

[greenberetTFS]

Guys,

I've bitten the bullet...The VA said no more cortisone shots but did approve the viscosupplement shots. However they will only allow one shot per week for a total of 6 shots over a 6 week period for both knees. The cortisone shots were given,both knees at the same time over a 3 month timeframe. They said it should last at least 6 months and hopefully longer. Sincere thanks for all the feedback you guys gave me,I really do appreciate it.....:D

GB TFS :munchin

[OIFDan]

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[greenberetTFS]

I've had 3 shots so far on my left knee and I'm just starting to get the first shot on my right knee. However after reading your post I'm not quite sure about it......:(

GB TFS :munchin

[OIFDan]

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[greenberetTFS]

OIFDan,Not to well. I've been measured for braces,but they haven't come in yet. I'll let you know once I get them on how there working for me..........

GB TFS

[OIFDan]

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[Boomer-61]

OIF,
Until your MRI comes back you should be fine to swim strokes like free style, the ones that don't stress the colaterals. Or running in place in deep water with a floatation vest on. Avoid the breast stroke. Stick with non-impact activities, especially ones that torque the knee. If the MRI shows only a sprain, you should be go to go in 6-8 weeks if you continue with the above protocol. Let us know the MRI results for a definitive plan.

[greenberetTFS]

I had my knee braces put on at the Biloxi VA yesterday. This is my response regarding the following. They look like a baseball catchers knee guards incredibly big and bulky. Wearing them under my pants isn't that easy. Putting them on isn't that easy. I wore them all day and I was glad to get them off because they hurt wearing them. Don't get me wrong I sincerely appreciate the VA's willingness to help, but I'm not sure these braces are going to work for me. I guess I'm going to have to bite the bullet and get the knee surgery.....................:(

GB TFS :munchin

[Red Flag 1]

I had my knee braces put on at the Biloxi VA yesterday. This is my response regarding the following. They look like a baseball catchers knee guards incredibly big and bulky. Wearing them under my pants isn't that easy. Putting them on isn't that easy. I wore them all day and I was glad to get them off because they hurt wearing them. Don't get me wrong I sincerely appreciate the VA's willingness to help, but I'm not sure these braces are going to work for me. I guess I'm going to have to bite the bullet and get the knee surgery.....................:(

GB TFS :munchin


I was hoping for better news:(.

PM inbound amigo.

RF 1

[doctom54]

I had my knee braces put on at the Biloxi VA yesterday. This is my response regarding the following. They look like a baseball catchers knee guards incredibly big and bulky. Wearing them under my pants isn't that easy. Putting them on isn't that easy. I wore them all day and I was glad to get them off because they hurt wearing them. Don't get me wrong I sincerely appreciate the VA's willingness to help, but I'm not sure these braces are going to work for me. I guess I'm going to have to bite the bullet and get the knee surgery.....................:(

GB TFS :munchin

I'm sorry to hear of al your knee problems. It sounds like everyone has done all the correct things.
I'm a Family practice doc who does a lot of the Synvisc injections. I agree with Boomer that they are about 60% effective; but they do buy people time before needing a replacement joint.
If the braces aren't working after a month or so trial it is time for knee replacement. About 85-90% of my patients are happy after that surgery,
Hope thing work out well for you.

[Red Flag 1]

greenberetTFS,

pm inbound.

RF 1

[Red Flag 1]

greenberetTFS,

PM inbound amigo!!

RF 1

[greenberetTFS]

I'm sorry to hear of al your knee problems. It sounds like everyone has done all the correct things.
I'm a Family practice doc who does a lot of the Synvisc injections. I agree with Boomer that they are about 60% effective; but they do buy people time before needing a replacement joint.
If the braces aren't working after a month or so trial it is time for knee replacement. About 85-90% of my patients are happy after that surgery,
Hope thing work out well for you.

doctom54,

Thanks for your response. I 'm scheduled to get my left knee replacement surgery in 5-6 weeks. The braces didn't work for me and I've postponed it for to long now. RF 1 is also a doctor and has supported me through out this situation. I'm just hoping at my age it won't be hard on me during the healing process..............

GB TFS

[Red Flag 1]

doctom54,

Thanks for your response. I 'm scheduled to get my left knee replacement surgery in 5-6 weeks. The braces didn't work for me and I've postponed it for to long now. RF 1 is also a doctor and has supported me through out this situation. I'm just hoping at my age it won't be hard on me during the healing process..............

GB TFS

pm inbound!

RF 1

[OIFDan]

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[doctom54]

Gentleman,
Specific to my case I just recieved this from the VA. In early FEB I had a non-impact twisting of my knee while getting onto a ski lift. Knee popped, MCL and ACL both Burned with pain around a 7 or 8. Finally recieve the results and this is how they read;
MRI Left Knee:

T1 coronal, fat saturated coronal, fat saturated axial fat saturated sagittal, T1 sagittal.
Osseous structures:
Minimal subcortical edema noted in the posterior medial plateau, but no fracture and the cartillage is intact. No other osseous pathology is identified. The patella appears normal.
Joint Spaces:
Minimal joint fluid, otherwise the joint spaces are intact.
Ligaments and tendons:
The anterior and posterior cruciate ligaments are intact, and the quadracepts and patella tendons are intact, and the collateral ligaments appear normal.
Menisci:
No meniscal tear. Minimal degenerative signal in the posterior medial meniscus.
Soft Tissues:
No significant focal soft tissue pathology.
Impression:
Minimal bony contusion in the medial tibial plateau, otherwise the study is normal.


Any idea what this MRI Result means gentlemen? If my knee appears normal, then why am I still having pain at the jointline on the inside lower portion of my left knee? And what exactly is a bony contusion? A bruise? Eagle or one of the other QP's have an idea about how to treat this? I've been off of it entirely since the beginning of Feb when it happend.
Thanks for the input,
-Dan

Basically this means that you did NOT tear any ligaments. You did NOT tear the meniscus (cushions). The inner aspect of the tibia is bruised. A true bone bruise can take several months to heal. I would recommend ibuprofen 800 mg 3 times a day and exercise such as swimming or biking where you don't place a big load on the knee. I guessing within a month you'll be good to go.

[greenberetTFS]

One injection....Lasts up to 6 months of Osteoarthritis (OA) knee pain relief.....:cool:
Synvisc-One is the only treatment of its kind that can deliver up to 6 months of OA knee pain relief with just one injection...................:D No more 6 shots ,3 each knee at one week intervals. It will save me a lot of gas money traveling from home to the VA.............;)

GB TFS :munchin

[Red Flag 1]

One injection....Lasts up to 6 months of Osteoarthritis (OA) knee pain relief.....:cool:
Synvisc-One is the only treatment of its kind that can deliver up to 6 months of OA knee pain relief with just one injection...................:D No more 6 shots ,3 each knee at one week intervals. It will save me a lot of gas money traveling from home to the VA.............;)

GB TFS :munchin

Great news Amigo!!!!

RF 1

[swpa19]

Are any of these injections cortisone base?

[doctom54]

Are any of these injections cortisone base?

NO

[swpa19]

Had to quit running because of Arthritis build up in my heels and knees. Have a fairly severe reaction to Cortisone. Woul love some relief and start jogging again, maybe help get rid of the extra 6 pounds Ive gained since quit smoking and jogging.

[greenberetTFS]

One injection....Lasts up to 6 months of Osteoarthritis (OA) knee pain relief.....
Synvisc-One is the only treatment of its kind that can deliver up to 6 months of OA knee pain relief with just one injection................... No more 6 shots ,3 each knee at one week intervals. It will save me a lot of gas money traveling from home to the VA.............;)

GB TFS :munchin

I meant to ask if anyone had heard of or may have had this injection ? ;)

GB TFS :munchin

[doctom54]

I meant to ask if anyone had heard of or may have had this injection ? ;)

GB TFS :munchin

I have heard of it but haven't used it on any patients yet. The drug rep is coming by next week and I'll push them on the data. Reps don't have an easy time at my office ;)

[Red Flag 1]

There are two web sites for this FDA approved product.

http://www.Synviscone.com pretty good site for patient information.

http://www.genzyme.com gives a bit more information.

Of note is the report that symptoms may take up to one month to improve. Reports that up to six months of symptom relief is possible. The injection of synviscone ( hylan G-F 20) can be repeated according to the literature.

I'll talk with the Ortho docs and get their input.

My $.02.

RF 1

[greenberetTFS]

There are two web sites for this FDA approved product.

http://www.Synviscone.com pretty good site for patient information.

http://www.genzyme.com gives a bit more information.

Of note is the report that symptoms may take up to one month to improve. Reports that up to six months of symptom relief is possible. The injection of synviscone ( hylan G-F 20) can be repeated according to the literature.

I'll talk with the Ortho docs and get their input.

My $.02.

RF 1

Thanks Jim for the follow-up............;)

Big Teddy