Viscosupplementation Treatment for Arthritis

Exploring determinants predicting response to intra-articular hyaluronic acid treatment in symptomatic knee osteoarthritis: 9-year follow-up data from the Osteoarthritis Initiative

Viscosupplementation Treatment for Arthritis | Johns Hopkins Medicine

  1. 1.

    Bruyere O, Cooper C, Pelletier JP, Maheu E, Rannou F, Branco J, Luisa Brandi M, Kanis JA, Altman RD, Hochberg MC, et al.

    A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis—from evidence-based medicine to the real-life setting. Semin Arthritis Rheum. 2016;45(4 Suppl):S3–11.

    • Article
    • PubMed
    • Google Scholar
  2. 2.

    McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363–88.

    • CAS
    • Article
    • PubMed
    • Google Scholar
  3. 3.

    Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465–74.

    • CAS
    • Article
    • PubMed
    • Google Scholar
  4. 4.

    Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62(12):1145–55.

    • CAS
    • Article
    • PubMed
    • PubMed Central
    • Google Scholar
  5. 5.

    Bhandari M, Bannuru RR, Babins EM, Martel-Pelletier J, Khan M, Raynauld JP, Frankovich R, McLeod D, Devji T, Phillips M, et al. Intra-articular hyaluronic acid in the treatment of knee osteoarthritis: a Canadian evidence-based perspective. Ther Adv Musculoskel Dis. 2017;9(9):231–46.

    • CAS
    • Article
    • Google Scholar
  6. 6.

    Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013;21(9):571–6.

  7. 7.

    Cooper C, Rannou F, Richette P, Bruyere O, Al-Daghri N, Altman RD, Luisa Brandi M, Collaud Basset S, Herrero-Beaumont G, Migliore A, et al. Use of intra-articular hyaluronic acid in the management of knee osteoarthritis in clinical practice. Arthritis Care Res (Hoboken). 2017;69(9):1287–96.

    • Article
    • PubMed
    • Google Scholar
  8. 8.

    Migliore A, Bizzi E, Herrero-Beaumont J, Petrella RJ, Raman R, Chevalier X. The discrepancy between recommendations and clinical practice for viscosupplementation in osteoarthritis: mind the gap. Eur Rev Med Pharmacol Sci. 2015;19(7):1124–9.

  9. 9.

    Altman RD, Schemitsch E, Bedi A. Assessment of clinical practice guideline methodology for the treatment of knee osteoarthritis with intra-articular hyaluronic acid. Semin Arthritis Rheum. 2015;45(2):132–9.

    • CAS
    • Article
    • PubMed
    • Google Scholar
  10. 10.

    Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;2:CD005321.

  11. 11.

    Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162(1):46–54.

    • Article
    • PubMed
    • Google Scholar
  12. 12.

    Rutjes AW, Juni P, da Costa BR, Trelle S, Nuesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. 2012;157(3):180–91.

    • Article
    • PubMed
    • Google Scholar
  13. 13.

    Raynauld JP, Pelletier JP, Abram F, Dodin P, Delorme P, Martel-Pelletier J. Long-term effects of glucosamine and chondroitin sulfate on the progression of structural changes in knee osteoarthritis: six-year followup data from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2016;68(10):1560–6.

    • CAS
    • Article
    • PubMed
    • Google Scholar
  14. 14.

    Roubille C, Martel-Pelletier J, Abram F, Dorais M, Delorme P, Raynauld JP, Pelletier JP. Impact of disease treatments on the progression of knee osteoarthritis structural changes related to meniscal extrusion: data from the OAI progression cohort. Semin Arthritis Rheum. 2015;45(3):257–67.

    • Article
    • PubMed
    • Google Scholar
  15. 15.

    Martel-Pelletier J, Roubille C, Abram F, Hochberg MC, Dorais M, Delorme P, Raynauld JP, Pelletier JP. First-line analysis of the effects of treatment on progression of structural changes in knee osteoarthritis over 24 months: data from the osteoarthritis initiative progression cohort. Ann Rheum Dis. 2015;74(3):547–56.

    • CAS
    • Article
    • PubMed
    • Google Scholar
  16. 16.

    Dodin P, Pelletier JP, Martel-Pelletier J, Abram F. Automatic human knee cartilage segmentation from 3D magnetic resonance images. IEEE Trans Biomed Eng. 2010;57:2699–711.

  17. 17.

    Dodin P, Abram F, Pelletier J-P, Martel-Pelletier J. A fully automated system for quantification of knee bone marrow lesions using MRI and the osteoarthritis initiative cohort. J Biomed Graph Comput. 2013;3(1):51–65.

  18. 18.

    Li W, Abram F, Pelletier JP, Raynauld JP, Dorais M, d'Anjou MA, Martel-Pelletier J. Fully automated system for the quantification of human osteoarthritic knee joint effusion volume using magnetic resonance imaging. Arthritis Res Ther. 2010;12(5):R173.

    • Article
    • PubMed
    • PubMed Central
    • Google Scholar
  19. 19.

    Berthiaume MJ, Raynauld JP, Martel-Pelletier J, Labonté F, Beaudoin G, Bloch DA, Choquette D, Haraoui B, Altman RD, Hochberg M, et al. Meniscal tear and extrusion are strongly associated with the progression of knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis. 2005;64:556–63.

    • Article
    • PubMed
    • Google Scholar
  20. 20.

    Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M, Simon L, Strand V, Woodworth T, Dougados M. OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthr Cartil. 2004;12(5):389–99.

    • CAS
    • Article
    • PubMed
    • Google Scholar
  21. 21.

    Altman RD, Devji T, Bhandari M, Fierlinger A, Niazi F, Christensen R. Clinical benefit of intra-articular saline as a comparator in clinical trials of knee osteoarthritis treatments: a systematic review and meta-analysis of randomized trials. Semin Arthritis Rheum. 2016;46(2):151–9.

    • CAS
    • Article
    • PubMed
    • Google Scholar
  22. 22.

    Altman R, Lim S, Steen RG, Dasa V. Hyaluronic acid injections are associated with delay of total knee replacement surgery in patients with knee osteoarthritis: evidence from a large U.S. health claims database. PLoS One. 2015;10(12):e0145776.

    • Article
    • PubMed
    • PubMed Central
    • Google Scholar
  23. 23.

    Wang Y, Hall S, Hanna F, Wluka AE, Grant G, Marks P, Feletar M, Cicuttini FM. Effects of Hylan G-F 20 supplementation on cartilage preservation detected by magnetic resonance imaging in osteoarthritis of the knee: a two-year single-blind clinical trial. BMC Musculoskelet Disord. 2011;12:195.

    • Article
    • PubMed
    • PubMed Central
    • Google Scholar


What Are Viscosupplement Injections?

Viscosupplementation Treatment for Arthritis | Johns Hopkins Medicine

Treating knee arthritis is a step-by-step process. Conservative, non-invasive treatment options are always tried first: rest, ice, activity/lifestyle modification, and medications are usually enough to reduce the symptoms of mild to moderate arthritis. But, when they’re not, minimally invasive treatments are available and widely used. One such treatment option is viscosupplementation.

Viscosupplements: What They Are

Viscosupplements contain hyaluronic acid—a natural substance found in the synovial fluid that surrounds and lubricates the knee joint.

During viscosupplementation, the supplements, which come in a gel- fluid, are administered via injection into the knee joint.

Because patients with knee arthritis have a lower-than-normal concentration of hyaluronic acid in their joint(s), viscosupplementation can increase their knee joint mobility and decrease their arthritis-related symptoms, such as stiffness and pain.

Illustration 1- Knee anatomy. Synovial fluid lubricates the joint.

Viscosupplements: What They Aren’t

Viscosupplements can help patients with knee arthritis, but they can neither cure the condition nor regrow torn/lost cartilage. In fact, no current treatment option can—arthritis is a chronic condition. The goal when treating is to slow the progression and decreasing/eliminating its presenting symptoms.

How Viscosupplements Are Used

Viscosupplements are usually used as part of a complete arthritis treatment plan prescribed by an orthopedic specialist. Some other treatment options that might be used in conjunction with viscosupplements are:

  1. Physical therapy. Increasing the range of motion and strength increases joint mobility.
  2. Nonsteroidal anti-inflammatory drugs decrease inflammation and pain.
  3. Knee braces may help keep the joint aligned and ensure it moves properly.

The supplements are administered once-a-week for a period of three to five weeks depending on the type of viscosupplementation regiment used. Following the last injection, they can be given again after six months.

Seeking Treatment

Orthopedic specialists are the most trained and qualified medical professionals to treat knee arthritis. Their understanding of the condition and experience treating it helps them create appropriate and effective treatment plans, that may include viscosupplementation.  Dr.

Nicholas Alexander is the founder of Mahwah Valley Orthopedic Associates and a Board Certified Orthopedic Surgeon specializing in both the surgical and non-surgical treatment of hip and knee conditions.  Dr.

Alexander completed his Fellowship in Adult Reconstruction and Reconstructive Surgery of the Hip and Knee at the Johns Hopkins School of Medicine and has over two decades of experience. He also serves as the Chairman of the Valley Hospital Total Joint Center. 

If you suffer from knee arthritis and haven’t found a solution, please don’t hesitate to contact our office to arrange an appointment.   We will provide you with the solution you’ve been looking for—the road to a normal, pain-free life starts when you walk through our doors.


Making Knees New Again

Viscosupplementation Treatment for Arthritis | Johns Hopkins Medicine

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How are your knees? If you’re many people age 50 and older, they’ve been aching. If you’re 65 or older, you may have some degree of osteoarthritis, in which the cartilage that cushions the ends of the bones in the joints begins to degenerate or wear away.

Symptoms can range from stiffness to severe pain and limited mobility. So it’s probably not surprising that surgeons perform more than 700,000 knee-replacement surgeries in the United States each year.

Total knee replacement is very effective, but implants don’t last forever. Although they can last 20 years, one study found that about 14.9 percent of men and 17.4 percent of women who receive a total knee replacement will need another. The earlier you get your implant, the more ly you’ll be back in surgery at some point.

That’s why knee replacement should only be considered after you’ve tried everything else, says Harpal S. Khanuja, M.D., chief of hip and knee replacement surgery with the Department of Orthopaedic Surgery at Johns Hopkins. That includes following your doctor’s recommendations for losing weight, physical therapy, pain management, and modifying your activities.

“I tell people it’s time for a replacement when they can’t live the life they want to live; it is not a good solution for an occasional pain,” Khanuja says.

To keep knee replacement as a last resort, keep your knees healthy with these smart steps.

Hit a healthy weight

Weight management is one of the top ways to fight osteoarthritis. Excess weight puts more pressure on your knees. This increases inflammation and ly contributes to disease progression. Every 10-pound loss relieves 30 pounds of force on your knee per step, says Khanuja.

One study found that overweight people who lost just 10 percent of their body weight experienced significantly less knee pain, could walk faster, and moved better. They also had lower levels of inflammation.

Get the right kind of exercise

Moderate physical activity won’t increase your risk of osteoarthritis. In fact, by helping you maintain a healthy weight, it can actually reduce the risk. If your knees hurt, however, be smart. Don’t start training for a marathon or join a basketball team. Instead, says Khanuja, try lower-impact exercise such as swimming, walking, or using an elliptical machine.

Toss the high heels

A study published in the journal Arthritis & Rheumatism found that wearing flat, flexible shoes significantly reduced pressure on knees and helped people with osteoarthritis walk better.

Cartilage (kahr-ti-lij): Tough, flexible tissue that covers the ends of bones, allowing our joints to move without pain or friction. It also is what gives shape to our noses, ears and windpipe. When cartilage becomes damaged or inflamed, movement can be painful or limited.

Inflammation (in-fluh-mey-shun): The redness and warmth around a cut or scrape is short-term inflammation, produced by the immune system to aid healing.

But another type called chronic inflammation, triggered by compounds from abdominal fat, gum disease and other factors, lingers in the body.

Research suggests this type increases the risk for heart disease, diabetes, dementia and some forms of cancer.


Engineering long-lasting joint lubrication by mimicking nature

Viscosupplementation Treatment for Arthritis | Johns Hopkins Medicine

By finding a way to bind a slippery molecule naturally found in the fluid that surrounds healthy joints, Johns Hopkins researchers have engineered surfaces that have the potential to deliver long-lasting lubrication at specific spots throughout the body. The finding, described in the Aug. 3 online edition of Nature Materials, could eventually offer a new way to ease the pain of arthritic joints, keep artificial joints working smoothly or even make contact lenses more comfortable.

According to the investigators, scientists have long known that a biochemical known as hyaluronic acid (HA), found in abundance in joints' synovial fluid, is an important component for naturally lubricating tissues. One form of HA also reduces inflammation and protects cells from metabolic damage.

Diseased, damaged or aging joints in hips, knees, shoulders and elbows often have far lower concentrations of HA, presumably because a protein that binds HA molecules to joint surfaces is no longer able to retain HA where it is needed. HA injections into painful joints, known as viscosupplementation, have become a popular way to treat painful joints in the past several years.

But without a way to retain HA at the site, the body's natural cleaning processes soon wash it away.

Seeking a way to tackle this problem, a team led by Jennifer H. Elisseeff, Ph.D., professor at the Wilmer Eye Institute at Johns Hopkins and in the Johns Hopkins University departments of Biomedical Engineering and of Materials Science and Engineering, looked to molecules known as HA-binding peptides (HABpeps) that stick to HA.

In the laboratory, using HABpep as a chemical handle, the researchers used a second synthetic molecule, polyethylene glycol, to tie HA onto surfaces that included natural and artificial cartilage.

Tests on tissues and in animals show that the bound HA didn't easily wash away, and it reduced friction as successfully as when these tissues were immersed in a bath of HA.

When the researchers injected a HABpep designed to attach to cartilage in rat knees, then injected HA, that HA stuck around 12 times as long as it did in rats that hadn't been given HABpep, suggesting that these peptides could be a promising addition to viscosupplementation.

Though this material still has some time before it might be available to patients, Elisseeff notes its promise as another way scientists have looked to nature as an inspiration to solve medical problems.

“What I about this concept is that we're mimicking natural functions that are lost using synthetic materials,” Elisseeff says.

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Story Source:

Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.

Journal Reference:

  1. Anirudha Singh, Michael Corvelli, Shimon A. Unterman, Kevin A. Wepasnick, Peter McDonnell, Jennifer H. Elisseeff. Enhanced lubrication on tissue and biomaterial surfaces through peptide-mediated binding of hyaluronic acid. Nature Materials, 2014; DOI: 10.1038/nmat4048


Knee Osteoarthritis: Injectable Medications

Viscosupplementation Treatment for Arthritis | Johns Hopkins Medicine

From the WebMD Archives

When you have pain, stiffness, or other problems because of knee osteoarthritis (OA), and other treatments haven't helped, your doctor may suggest injections to ease your symptoms.

Shots in your knee joint are an option if you don’t get relief from a pain reliever acetaminophen or ibuprofen, says Jemima Albayda, MD, a rheumatologist at Johns Hopkins University. Your doctor may also suggest injections if you can't take those drugs because of side effects.

The shot may be a little uncomfortable, but it shouldn't be very painful. To lessen the chance of infection, your doctor will clean your knee before giving you the shot.

If you have fluid in your knee, your doctor may drain it first. She may give you a numbing injection or spray before the shot of medicine.

There are several different kinds of injections, Albayda says, but the two main types for osteoarthritis are:

  • Corticosteroids
  • Viscosupplements with hyaluronic acid

Cortisone-type shots help ease joint inflammation. 

Fast relief. You may feel better as soon as you get the shot because you are numbed first, says Craig Bennett, MD, an orthopaedic surgeon at the University of Maryland Rehabilitation & Orthopaedic Institute. But when that wears off, you should feel relief of symptoms within a couple of days. Relief from these injections can last for several weeks to several months.

You can't use them very often. “Corticosteroids generally work more powerfully and better the first time in,” Bennett says. Each time after that, you may get a little less relief. In most cases, Albayda suggests that people with OA get the shot no more than every 3 months.

Complications from injections are rare but can happen. Talk to your doctor to know your risks. You can also have a flare right after you get the shot. Getting corticosteroid injections can also affect blood sugar temporarily, so this may be a concern for several days if you have diabetes.

Hyaluronic acid is the fluid inside your knee. It keeps the bones in the joints moving smoothly against each other. When you have OA, the fluid changes and contributes to inflammation. These injections provide a man-made version of that fluid. This treatment is often offered to people who get no relief from pain relievers.

“I tell my patients it's an oil job,” Bennett says. “It's going to give your joint the same concentration and the same type of fluid that a healthy non-arthritic joint should have.”

You may need more than one shot. Some hyaluronic acid injections provide relief with just one injection, but others come in a series of injections.

Relief takes time. Because these injections aren't usually given with a numbing drug, there's no immediate pain relief you get with a steroid shot. It typically takes about a week or more before you start to feel better, Bennett says. The effect may last longer than cortisone shots — up to 6 months or more.

They're expensive. These treatments are also typically more expensive than cortisone shots, says Joseph Bosco, MD, an orthopaedic surgeon at NYU Langone Medical Center’s Hospital for Joint Diseases. “With all these injections, be sure to ask your doctor if insurance will cover it and how much will it cost.”

Some doctors are using this type of knee injection to treat knee OA symptoms. Doctors take your blood and collect the platelets, the part of blood that forms clots. They increase the number of platelets and inject them into your knee. Natural chemicals in platelets help heal injuries and lower inflammation.

Experts are still researching how well it works for osteoarthritis. It's very expensive and still in early stages of research, Albayda says, so it's not a mainstream form of OA treatment.


Jemima Albayda, MD, rheumatologist, Johns Hopkins University.

American Academy of Orthopaedic Surgeons: “Platelet-Rich Plasma (PRP).”

Craig Bennett, MD, orthopaedic surgeon, University of Maryland Rehabilitation & Orthopaedic Institute; head orthopaedic surgeon, University of Maryland Athletic Department.

Joseph Bosco, MD, orthopaedic surgeon, Hospital for Joint Diseases, NYU Langone Medical Center.

Halpern, B. Clinical Journal of Sports Medicine, May 2013.

© 2014 WebMD, LLC. All rights reserved.


Niels J. Linschoten, M.D. — Baton Rouge Orthopaedic Clinic

Viscosupplementation Treatment for Arthritis | Johns Hopkins Medicine

Dr. Linschoten (pronounced Lynn-Show-Ten) was born in The Netherlands, raised in the Caribbean, and settled in Baton Rouge in l992. He married a nice Cajun girl from Gonzales in 2013.

He attended medical school in the city of Utrecht and completed a residency in Orthopaedic Surgery at the Johns Hopkins Hospital in Baltimore, Maryland after which he further subspecialized in total joint replacements at the Cleveland Clinic in Cleveland, Ohio.

Dr. Linschoten is part of the Baton Rouge Orthopedic Clinic, a 35+ strong Orthopedic group, with multiple locations in and around Baton Rouge.

At the Baton Rouge Orthopaedic Clinic most every orthopedic surgeon is subspecialized. Dr. Linschoten’s area of expertise is total hip and knee replacements, as well as hip and knee revisions and the management of complex total joint situations. Dr.

Linschoten often receives referrals from other orthopedic surgeons throughout the region. He is trained on Stryker's Mako Robotic Assisted Surgical System.

He is one of the first physicians in Baton Rouge to use this technology to perform knee replacement surgery at the Baton Rouge General.

Dr. Linschoten and his team can be reached via the Baton Rouge Orthopaedic Clinic: 225-924-2424 or directly at our current satellite location within the Baton Rouge General office tower #2: 225-478-8722. 

Our current address is: 8585 Picardy, Ste. 518, located within the Baton Rouge General Hospital, Entrance #2 (complimentary valet parking).

More information is available at


  • Doctor of MedicineState University of Utrecht, Holland
  • Post GraduateGeneral SurgeryState University of Utrecht, Holland


  • InternshipThe John Hopkins Hospital(Baltimore, MD), General Surgery
  • ResidencyThe John Hopkins Hospital(Baltimore, MD), General SurgeryThe John Hopkins Hospital(Baltimore, MD), Orthopaedic Surgery
  • FellowshipsThe Cleveland Clinic (Cleveland, OH)Adult Reconstruction and Joint Replacements


  • Diplomat, American Board of Orthopaedic Surgery
  • The John Hopkins Medical Society
  • American Academy of Orthopaedic Surgeons
  • American Association of Hip and Knee Surgeons

Baton Rouge General launches robotic surgical equipment to make knee surgery easier

Other Conditions and Treatments


Knee injections or knee replacement: What are my options?

Viscosupplementation Treatment for Arthritis | Johns Hopkins Medicine

Osteoarthritis is a degenerative joint disease that can cause problems with the knees. Treatments for this include injections into the knee and replacing tissue in the knee. Which is best for treating osteoarthritis?

The condition often affects people aged 50 years and older, although it can also occur in younger people. According to the Arthritis Foundation, over 50 million people in the United States have arthritis.

Osteoarthritis (OA) is a chronic condition that causes the breakdown of cartilage between the joints. Cartilage serves as a cushion for joints and protects the surface of the bones. Without this cushion, bones can rub or grind together, causing pain, stiffness, and swelling.

If a patient continues to experience discomfort, swelling, or extensive joint damage, their doctor may suggest knee replacement or a knee injection.

Doctors will typically recommend knee injection therapy before recommending surgery. For some people, injections help to alleviate knee pain.

Corticosteroid injections

Corticosteroid injections are among the most common knee injections. Doctors inject corticosteroids directly into the knee joint to help relieve knee pain and inflammation quickly.

They are a class of medications related to the steroid cortisone. They are routinely used to reduce inflammation. Corticosteroids mimic the effects of a substance called cortisol that is naturally produced by the adrenal glands.

In high doses, corticosteroids can reduce inflammation. They also effect the immune system. This can be helpful for controlling conditions in which the immune system mistakenly attacks its own tissues, such as rheumatoid arthritis.

The corticosteroid is absorbed into the bloodstream quickly and travels to the inflammation site. Injection therapy provides rapid relief to the inflamed area and is more powerful than traditional oral anti-inflammatory medications.

In addition to providing quick relief, the injection does not cause many of the side effects that oral corticosteroid medications do.

Doctors can administer the injection in their office. They may numb the knee area before injecting the corticosteroid drug directly into the joint. Some people feel almost immediate relief, while others feel the effects several days later.

Depending on the condition of the knee, the benefits can last from a few days to more than 6 months. Factors that play a role in how long the effects of the steroid injection will last such as the extent of inflammation and overall health. It is important to note that the effects of the shot are temporary.

Additional cortisone injections may be necessary.

Many people have no adverse effects after a steroid injection besides a little pain or tingling where the injection was made. However, corticosteroids can cause dangerous side effects for some people, especially when taken too often.

Side effects include:

  • the death of nearby bone, known as osteonecrosis
  • joint infection
  • nerve damage
  • thinning of the skin and soft tissue around the injection site
  • a temporary flare of pain and inflammation in the joint
  • the thinning of nearby bone, known as osteoporosis
  • whitening or lightening of the skin around the injection site
  • diabetic patients can experience elevated blood sugar
  • allergic reaction

Exposure to high levels of cortisol over a prolonged period of time increases the risk of developing hypercortisolism or Cushing’s syndrome.

These effects include:

  • upper body obesity
  • a round-shaped face
  • increased bruising
  • trouble healing
  • weak bones
  • excessive hair growth
  • irregular menstrual periods in women
  • fertility problems in men

This side effect is treated by gradually reducing the amount of cortisone used or adjusting dosage.

Other injections

Some people have tried platelet-rich plasma or stem cell injections, but both the American College of Rheumatology and the Arthritis Foundation advise against using these treatments.

There is no standard procedure for either approach, and a person will not know exactly what is in their injection. Also, there is not enough evidence to show that these options are safe or effective.

Though corticosteroid control pain and inflammation efficiently, it only provides temporary relief. As OA progresses, mobility and quality of life may get worse, leaving a knee replacement as the only option.

A doctor will ly recommend knee replacement surgery once all other treatment options such as physical therapy and injections have been tried.

A knee replacement is also referred to as knee arthroplasty or knee resurfacing, because only the surface of the bones is replaced. The surgeon will cut away damaged bone and cartilage from the shinbone and kneecap, and then replace it with an artificial joint.

During a total knee replacement, the damaged knee joint is removed and replaced with a prosthesis made metal, ceramic, or high-grade plastic, as well as polymer components.

There are four basic steps:

  • Preparing the bone: The cartilage surfaces that are found at the end of the femur and tibia are removed along with a small amount of underlying bone.
  • Positioning the metal implants: The removed cartilage and bone are then replaced with metal components to recreate the surface of the joint. The metal parts are either cemented or “fit” into the bone.
  • Resurfacing the patella: The undersurface of the patella, or kneecap, may be cut and resurfaced with a plastic button.
  • Inserting a spacer: The surgeon inserts a medical-grade plastic between the metal components to create a smooth gliding surface, making walking easier and smoother.

Before the procedure, patients will work alongside doctors to design their artificial knee. A range of factors is taken into account, such as age, weight, activity levels, and overall health.

Delaying your surgery

There are risks associated with delaying knee replacement surgery. The main risks are further deterioration of the joint, increased pain, and reduced mobility.

Other risk factors include:

  • a risk of deformities developing inside and outside the joint
  • a risk of muscles, ligaments, and other structures becoming weak and losing function
  • increased pain or an inability to manage pain
  • increased disability or lack of mobility
  • difficulty with normal daily activities

The doctor will thoroughly explain the procedure and allow the patient to ask questions as needed. They will record a medical history, including any medications or supplements currently being taken, also taking allergies and previous health problems into account.

The doctor will give the individual general anesthesia before the surgery, making them completely unconscious. Patients often begin physical therapy to get the new joint moving during a short hospital stay. Rehabilitation continues after leaving the hospital. This can help regain strength and range of motion.

Knee replacement risks

Though knee replacement surgery often goes smoothly, any surgery comes with risks.

These include:

  • infection
  • blood clots in the leg vein or lungs
  • heart attack
  • stroke
  • nerve damage

If surgery is postponed for too long, other risks may arise. Deformities may develop that complicate the knee replacement procedure. Surgery may take longer, and knee replacement options may be limited.

Learn more about the causes of severe knee pain here.


Knee Injections for Osteoarthritis: What to Expect

Viscosupplementation Treatment for Arthritis | Johns Hopkins Medicine

Osteoarthritis of the knee can affect anyone, but it usually develops in people over age 50. It’s a progressive disease, meaning it becomes more painful and difficult to move your knee over time.

Your doctor will probably prescribe oral medications and suggest lifestyle modifications before recommending knee injections. Before you turn to surgery, weigh the pros and cons of injections.

Read on to learn about the different types of knee injections and how they work, and find tips for taking care of your knees.

These are the main types of knee injections used in the treatment of osteoarthritis.


Corticosteroids are designed to be similar to cortisol, a hormone that is naturally produced in the body. The main purpose is to reduce inflammation.

Although oral corticosteroids are used to treat rheumatoid arthritis, which is a systemic disease, this isn’t an option for osteoarthritis.

If you have osteoarthritis in your knee, corticosteroids are most effective when injected directly into the joint. It’s a targeted treatment to reduce inflammation so bone doesn’t rub on bone as you move your knee.

The following medications are types of corticosteroids:

  • methylprednisolone
  • triamcinolone acetonide (Kenalog, Triesence, Zilretta)
  • triamcinolone hexacetonide (Aristospan)

Hyaluronic acid (viscosupplements)

If you have osteoarthritis, you probably don’t have enough hyaluronic acid in your knees. This substance helps to coat your cartilage and acts as a lubricant and shock absorber so your knee can move freely.

Learn more: Viscosupplements: Comparing your options »

This thick medication serves to supplement your own hyaluronic acid and keep the bones from scraping against each other. It may also help decrease inflammation and ease pain.

The following medications are types of hyaluronic acid injections:

  • sodium hyaluronate (Euflexxa, Hyalgan, Supartz)
  • high-molecular-weight hyaluronan (Monovisc, Orthovisc)
  • hylan G-F 20 (Synvisc, Synvisc One)
  • cross-d hyaluronate (Gel-One)

Fluid aspiration (arthrocentesis)

Rather than injecting something into the knee, this procedure takes fluid the knee. Removing excess fluid may provide immediate relief from pain and swelling. This is sometimes done prior to receiving an injection of corticosteroids or hyaluronic acid.

Knee injections can be administered in your doctor’s office. The procedure only takes a few minutes.

You’ll be seated during the procedure, and your doctor will position your knee. In some cases, they’ll use an ultrasound to help guide the needle to the best location.

First, the skin on your knee will be cleaned and treated with a local anesthetic. Your doctor will insert the needle into your joint. You might feel some pressure or mild discomfort. Then the medication will be injected into your joint.

In some cases, a small amount of joint fluid is removed first to make room for medication. For this, the doctor will use a needle attached to a syringe to enter the knee joint. The fluid is then aspirated into the syringe and the needle removed.

After the fluid is removed, the same puncture site can be used to inject the appropriate medication into the joint.

A small bandage will be placed over the injection site and you’ll be able to go home fairly quickly. Your doctor may advise you to avoid straining your knees for the next day or so. Your knee may feel tender for a few days. Ask if there are any driving restrictions.

Before weighing the pros and cons, you’ll want to ask your doctor which type of injection they’re planning to give you. Each type carries its own set of pros and cons.

Potential pros and cons of hyaluronic acid injections

The injection can provide relief from pain and swelling, but it’s not immediate. Studies show that it takes about five weeks before you feel the full effects of the treatment. Relief may last from three to six months. Some people are not helped by hyaluronic acid injections.

Potential side effects include:

  • mild injection site skin reaction
  • arthritis flare-up immediately following the injection

Hyaluronic acid injections are administered differently depending on the manufacture or preparation being used. Some require one injection and others require several injections given weekly.

Potential pros and cons of fluid aspiration

Removal of excess fluid can provide immediate relief from pain and discomfort. Side effects may include bruising, swelling, or infection at the aspiration site.

Following injections of the knee, notify your doctor if you have any signs of infection.

The effectiveness of these treatment methods varies from person to person. A lot depends on how far your arthritis has progressed. Some people respond well, but others get no relief.

Your doctor can advise you about which injections might be beneficial to you. If injections don’t work, talk to your doctor about your other treatment options, which may include stronger pain medications or surgery.

Read more: Alternatives to knee replacement surgery »

No matter what treatment you get for osteoarthritis of the knees, you should also take other steps to care for your knees. Here are a few tips to get started:

  • Try to minimize activities that strain your knees. Use an elevator or escalator instead of stairs, for example.
  • Avoid high-impact activities such as running or tennis. You can replace them with swimming, cycling, or walking, which are great forms of exercise that are also easy on the knees.
  • Maintain a healthy weight or lose a few pounds if you need to. Extra weight strains your knees.
  • Use heat and ice to soothe your knees.
  • If your knees are interfering with mobility, try wearing a knee brace or using a cane.
  • Consider physical therapy or a personalized exercise program with someone who is knowledgeable about osteoarthritis.