What are hyalurans? Hyalurans are naturally occurring substances in the synovial fluid of joints that essentially serve as joint lubricants, reducing friction and excessive bone wear and tear.  In osteoarthritis, this natural lubricant starts to thin out and work ineffectively.  One approach to arthritis treatment is to inject hyalurans into the knee in an effort to temporarily restore this cushioning effect.  Hyaluran injection can result in relief of arthritis pain that typically lasts for about six months, but can last as long as a year.  The first hyaluran introduced to the U.S. market back in the mid-1990’s was Hyalgan – a five injection series over five weeks!  Most series since then involve three injections over three weeks.  One product has now been available for several years as a single injection.

Does insurance pay for this treatment? Most plans cover a series of hyaluran every 3-6 months for patients with documented osteoarthritis of the knee.  It is not considered a covered benefit for arthritis of other joints.

Do hyalurans work? Studies looking at the effectiveness of hyaluran treatments are mixed, with some showing benefit and others showing little treatment effect.  Anecdotally, there is no question that some patients in our office with symptomatic osteoarthritis of the knee do get relief from these injections, returning periodically for a repeat shot when their symptoms return.  There is really no way of knowing if a patient with arthritis will respond to injection of hyaluran until it’s been tried.

Are hyalurans potentially effective for arthritis in other joints? The vast majority of hyaluran injections are done on the knee, and there isn’t enough information to be able to say one way or another whether these injections are effective for osteoarthritis in other joints.  Having said that, there is little risk from injecting, for example, an arthritic hip or ankle, and it theoretically could be beneficial, since the disease process is often similar.  Hyalurans are only FDA approved for use in the knee, however, so injections into other joints would not be covered and the cost for the procedure would fall to the patient.  Typically, this could run from about $250 for small joints to as much as $850

for a hip (more product required).

What would I experience if I go to Stadia for hyaluran injections?

• First, we would confirm with the patient what they would like injected.  The three injection series that we use is Orthovisc.  The advantage to Orthovisc is that there is a very low rate of allergic reactions to the product because of the way that it is made.  The disadvantage is that the treatment involves three injections over three weeks.  The one injection option is Synvisc One.  Synvisc One carries a 1-2% risk of an allergic reaction that can cause a temporary uncomfortable swelling in the knee.  If this occurs, the fluid can be easily drawn off.  The advantage, of course, is that 98-99% of the time, it is a one shot treatment.
• Typically, we will use ultrasound guidance for your injection under the following circumstances:
  • If the leg being injected is large enough that surface landmarks are difficult to identify.
  • If Synvisc One is being used.

The reason for use of guidance is to ensure entry into the joint.  For a joint as large as the knee, one might think that it would never be missed, but medial studies that have looked at the success rate for knee injections in an outpatient orthopedic setting show that the knee is missed about 20-25% of the time.  Thus, it is reasonable to do a three injection series blindly (assuming normal leg girth), since there is a high statistical probability that the joint will be successfully entered at least 2/3 times.  For a single injection treatment that won’t be authorized again by an insurer for 3-6 months, it is our opinion that it is best to use guidance to ensure 100% accuracy of placement.

• Our usual procedure for any injection at Stadia is to numb the area where the injection will occur with a small amount of local anesthetic using a very tiny needle.  We also spray a cooling agent on the skin prior to the numbing injection so that the patient feels virtually no pain.  One the patient is adequately numbed, the area is re-cleansed and the actual injection carried out, with or without guidance technology.  This results in a procedure that is as comfortable for the patient as possible – one of our goals.  Most patients are quite surprised at how painless these procedures actually are.
• Patient instructions after hyaluran injection are simply to maintain routine activity and to monitor symptoms for trends in improvement.  Typically, a reduction in pain begins within 7-10 days.