Viscosupplementation for Joint Pain

Janet D. Pearl, MD, MSc

Suffering From Pain?

We Can Help

Suffering From Pain?

We Can Help

Suffering From Pain?

We Can Help

Suffering From Pain?

We Can Help

Viscosupplementation (for Joint Pain)

What is it?

Viscosupplementation is a medical procedure during which a lubricating, gel-like  fluid is injected into a joint, usually the knee. Viscosupplementation is most commonly used to treat symptoms of knee osteoarthritis. In this procedure, your doctor injects the gel-like fluid called hyaluronic acid into the knee joint.

Hyaluronic acid occurs naturally in the joint fluid, where it acts as a cushion to protect joints from load and impact, and as a lubricant that allows bones to move smoothly.  Since people with osteoarthritis have lower levels of this compound in the affected joints, adding hyaluronic acid to the joint through viscosupplementation should increase the joint cushioning, improve movement and reduce pain.  It can also have moderate anti-inflammatory action. By decreasing friction within the joint, viscusupplementation reduces pain due to arthritis.



Who can benefit from viscosupplementation?

Viscosupplementation is recommended for the treatment of osteoarthritis, being mainly used for knee osteoarthritis. Viscosupplementation is an option when osteoarthritis patients have pain that affects daily activities, such as extended standing and walking, and when adequate pain relief is not obtained from medications, joint aspirations, steroid injections, or when these are unwanted.  In short, viscosupplementation is most appropriate for patients who have exhausted other medical treatments and want to delay or avoid knee surgery.

viscosupplementation for joint pain


Viscosupplementation should be administered by a specialist because these injections require precision and the injection technique is extremely important for its efficacy and tolerance. For viscosupplementation to be most effective, the hyaluronic acid is injected directly into the interior of the joint that contains cartilage and joint fluid.

Some types of viscosupplementation treatment require a one-time injection, while others, depending on the product used, may require one injection a week for approximately 3 weeks. When there is swelling in the knee, the excess fluids may be removed the hyaluronic acid is injected. For the first 48 hours after the injection, excessive weight bearing on the injected area should be avoided, such as standing for long periods of time, jogging or heavy lifting.

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How effective is it?

Although some patients report pain relief with the procedure, it is not effective for everyone. Younger patients and patients with less-severe forms of osteoarthritis usually get greater benefit from viscosupplementation than do older patients and those with more advanced forms of the disease.

When viscosupplementation is successful, it may take several weeks to notice an improvement. The greatest pain relief is usually observed between 5 and 13 weeks after the injection, but in some cases, it can provide pain relief for several months or even a year. When pain relief wears off, another series of injections may be administered. A minimum of 3-6 months is usually required before an additional round of injections. However, if the initial knee injection series does not provide meaningful pain relief, subsequent injections are not likely to be effective and are usually not recommended.  Viscosupplementation treatments may lose efficacy after some time due to the progression of osteoarthritis.

Can there be complications?

Viscosupplementation is considered a safe procedure, but side-effects may be felt if the injection is not precise and enters the soft tissue surrounding the knee joint instead of the joint space. Viscosupplementation may not be suitable for patients who have a knee joint infection, a skin disease or infection at or near the site of injection, bleeding disorders, or a known allergy to hyaluronic acid.  Patients who undergo viscosupplementation may have mild discomfort immediately after the procedure. Typical side effects at the injection site include localized swelling, skin warmth and redness, soreness, and joint stiffness. But these side effects are usually mild and go away in 1 to 2 days.

viscosupplementation FDA

Viscosupplementation & Corticosteroids: What’s The Difference?

There are several treatment options available for people experiencing joint pain, including physical therapy, injections or surgery. If you’ve looked into what’s available for your joint pain, chances are you’ll have come across corticosteroid (also known as cortisone) injections and you may be wondering how these differ from viscosupplementation.

Corticosteroid is an anti-inflammatory medicine that is similar to the steroids produced by our own bodies. A corticosteroid injection is designed to reduce pain, swelling and stiffness caused by inflammation in the joint.  Viscosupplement formulas are made with hyaluronic acid, which is a naturally occurring substance that helps lubricate your joint and absorb shocks. While it also reduces pain, swelling and stiffness in the joints, it does this by boosting low hyaluronic acid levels in the joint rather than by reducing inflammation.

Both types of injections will start to give you some relief after 48 hours, however, the effects of viscosupplementation generally last for longer. The effect of corticosteroid varies from person to person, but usually lasts for about six weeks. Viscosupplementation on the other hand can last for six months to a year.  Like most medicines, both corticosteroid and viscosupplementation can have side effects such as pain and soreness at the injection site. However, studies have shown that there are fewer side effects with viscosupplementation than with other treatments, and these tend to be less severe and long lasting. You can also have viscosupplementation as many times as you need, but there is a limit to the number of corticosteroid injections you can have because repeated injections can deteriorate the cartilage in the joint.

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