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Joint Fluid Replacement (Viscosupplementation) for Painful Arthritis

Joint fluid replacement (viscosupplementation) is a nonsurgical alternative treatment for patients suffering from painful arthritis. Although it is approved by the FDA for osteoarthritis of the knee, doctors have also used it to treat other joints, such as ankles or hips, with generally positive results. A 2006 Cochrane Review of joint fluid replacement found that pain levels in patients were reduced by 28 to 54 percent, and their ability to function improved by 9 to 32 percent. While some studies have found joint fluid replacement to be less effective, physicians still consider the evidence to be mostly supportive. Most importantly, current research suggests that this treatment may encourage natural production of necessary fluids, which could help to preserve cartilage.

Healthy joints move smoothly with the help of synovial fluid, which functions as a lubricant and shock absorber. People suffering from arthritis experience a breakdown in hyaluronic acid, a component of synovial fluid. Joint fluid replacement, also known as hyaluronic acid (HA) injection, consists of injecting a small amount (about 2mL) of this fluid into the joints to lessen joint pain and inflammation. In order to make room for the hyaluronic fluid, a small amount of joint fluid might need to be removed, or aspirated, from the area before the HA injection.

HA injections can be quickly administered in the doctor’s office. Because it has been used for over twenty years, it is usually covered by insurance. Patients receive a weekly injection for one to five weeks, depending on which of the five available treatments is used. They should avoid excessive activities for about two days following the shot, and administer ice treatments in twenty minute intervals. Afterward, patients should engage in a rehabilitation program in order to improve the range of motion and develop muscle strength. This may extend the effectiveness of the treatment, which can be repeated after about six months.

Some possible adverse effects of the treatment include pain and fluid buildup. However, the risks are minimal, and most doctors believe it is worthwhile, especially for those in the early stages of osteoarthritis. While the pain relief from joint fluid replacement is comparable to what a patient might expect from taking nonsteroidal anti-inflammatory drugs (NSAIDs), symptom relief may last up to two years. Plus, joint fluid replacement is generally offered when a patient can no longer tolerate or find relief from NSAIDs. It takes about five weeks for a patient to begin to feel the benefits of HA injections, while corticosteroid injections take only a few days. However, the overuse of corticosteroid treatments could cause cartilage to deteriorate further.

Patients wishing to avoid surgery may wish to receive joint fluid replacement by Dr. Sammy Masri and follow up with physical therapy for optimal results. Despite some studies claiming the results of joint replacement treatments are minimal, the overall evidence suggests that joint fluid replacement is safe and beneficial for patients suffering from arthritis.


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; 19(2): CD005321

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;162:46–54. doi: 10.7326/M14-1231

Gower T. Hyaluronic Acid Injections for Osteoarthritis. www.arthritis.org. Http://www.arththritis.org/living-with-arthritis/treatments/medication/drug-types/other/hyaluronic-acid-injections.php. Published 2017. Accessed January 2018.

Reid MC. Viscosupplementation for Osteoarthritis: a Primer for Primary Care Physicians. Advances in therapy. 2013;30(11):967-986. doi:10.1007/s12325-013-0068-6.

Wu B. Knee Injections vs. Knee Replacement: What are My Options? Medical News Today. MediLexicon, Intl., 31 May. 2016. Web.
20 Jan. 2018. <https://www.medicalnewstoday.com/articles/310606.php>

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