Viscosupplementation

[Rpoole8537]

I have had knee problems for 40 years. I played basketball and tennis in my teens and twenties and always had to manage the pain a bit. In my late twenties I started to run and four years later started having severe pain. So much that I started riding a bike and that was 27 years ago. Knee pain was so bad 12 years ago that I had microfracture on the right knee. Although the recovery was longer than anticipated, the pain did subside after a while. The doctor did say that the next procedure would be a cartilage graft. Fast forward 12 years and I am once again experiencing so much pain that I have curtailed my riding and especially difficult rides in the hills and mountains where I live. I local medical group is offering viscosupplementation and PT which they say when paired together they have an 85% success rate. It sounds too good to be true, and most likely is a stretch. It will not be a long term fix, but it might be sufficient to ride pain free throughout the late summer and fall. Anyone have experience with this procedure? Any other suggestions/advise?

[scooter]

From a clinical study in the Annals of Internal Medicine 2012: "Conclusion: In patients with knee osteoarthritis, viscosupplementation is associated with a small and clinically irrelevant benefit and an increased risk for serious adverse events.

http://annals.org/article.aspx?articleid=1305531

[thwart]

Most medical studies do not show any dramatic benefit, frequently no benefit at all.

In your situation, the '85%' could be mostly from physical therapy. Although again, most medical studies looking at PT alone for osteoarthritis of the knee show it's not significantly helpful.

That all said, I've seen folks who've had significant improvement in their symptoms after these injections. A classic situation of YMMV. As I'm sure you're already aware, it's a profitable enterprise for orthopedic clinics.

A bit off topic, but I've got a friend who is going to have stem cell treatment for his osteoarthritis, hoping to put off total knee replacement for awhile. That I know very little about... experimental stuff.

[Rpoole8537]

To respond to Thwart and the stem cell injections, I have a friend who is a Nurse Practitioner. A clinic recruited her to do the stem cell injections on their patients. It was a chiropractor who stated that she would be supervised by a medical doctor. The pay was great and the hours were more suitable to parenthood. She did her own research to determine if this was something she wanted to do and determined that the incidence of staff infections was as high as 20%. She later learned that the MD pulled out because of the various issues related to the situation. Tell your friend to do his due diligence.
I get some relief from Mobic and ice. However, I had serious Afib and Aflutter two years ago, and recent warnings about anti-inflamatories state that they can result in strokes and heart failure. I take it when I coming into a week when the temps, the weather and my schedule will be conducive to riding. I'm also not crazy about cortisone as many state it breaks down the tissue in the joint even more. I also wear a brace often. I'm just not ready to do the next level of surgery.

[buddybikes]

Visco helped me. Yes that 1 study came out and insurance pulled support - sucks.
here is some more information

http://www.huffingtonpost.com/kevin-r-stone-md/cortisone-the-end-of-an-era_b_7780880.html

[metalheart]

I had several rounds of viscosupplementation prior to knee replacements. The first set of injections helped some during an especially painful episode, but it was very short term relief, maybe two to three months. I noticed less benefit for a shorter amount of time for the other two sets of injections. IMHO it is really a stop-gap treatment prior to a longer term solution......

[djg21]

I have had knee problems for 40 years. I played basketball and tennis in my teens and twenties and always had to manage the pain a bit. In my late twenties I started to run and four years later started having severe pain. So much that I started riding a bike and that was 27 years ago. Knee pain was so bad 12 years ago that I had microfracture on the right knee. Although the recovery was longer than anticipated, the pain did subside after a while. The doctor did say that the next procedure would be a cartilage graft. Fast forward 12 years and I am once again experiencing so much pain that I have curtailed my riding and especially difficult rides in the hills and mountains where I live. I local medical group is offering viscosupplementation and PT which they say when paired together they have an 85% success rate. It sounds too good to be true, and most likely is a stretch. It will not be a long term fix, but it might be sufficient to ride pain free throughout the late summer and fall. Anyone have experience with this procedure? Any other suggestions/advise?

I had Synvisc injections for a few years in the hope of avoiding a TKR at a relatively young age. I can say definitively that Synvisc did not hurt, but I cannot say that it helped at all. I delayed the TKR for a while, but probably could have done that without Synvisc, and I cannot say that it reduced pain or improved my quality of life. My sense, as a patient unschooled in medicine, it that if your knee is already badly damaged or you suffer from advanced osteoarthritis and the damage already is done, Synvisc will be less effective than it would be if your condition is detected at an earlier stage.

As to your doc's representation of an 85% success rate, I'd be very skeptical and ask how he defines "success." If it means delaying surgical intervention for a time, the number is of dubious value. If it means that patients felt they experienced less pain after treatment, I'd be even more skeptical.