Frederick F. Buechel, Jr., M.D. | Orthopaedic Surgeon | (239) 659-5633 (KNEE)
MAKOplasty®  Destination Center
Frederick F. Buechel, Jr., M.D. | MAKOplasty International Destination Center | 239-659-5633 (KNEE) Physicians Regional Medical Center, 6101 Pine Ridge Road, Second Floor, Naples, FL 34119 2012 (C) by Robotic Joint Replacement Center
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 MAKOplasty® International Destination & Training Center of Excellence
Frederick F. Buechel, Jr., M.D. | MAKOplasty® International Destination Center | 239-659-5633 (KNEE) Physicians Regional Medical Center, 6101 Pine Ridge Road, Second Floor, Naples, FL 34119 2014 © by Robotic Joint Replacement Center
Frederick F. Buechel, Jr., M.D. Board Certified Orthopaedic Surgeon  MAKOplasty® Robotic Knee Resurfacing & Total Knee Replacement Specialist (239) 659-5633 (KNEE)
Visco-Supplement Injection Therapy (Hyaluronic Acid) Viscosupplementation is a relatively new procedure that involves the injection of gel-like substances (hyaluronates) into a joint to supplement the viscous properties of synovial fluid.  Hyaluronic acid and lubricin are two of the bodies lubricating substances found in joints.  As people age, the molecular weight of hyaluronic acid decreases in the knee joint.  The injections are believed to supplement the viscosity of the joint fluid, thereby lubricating the joint, cushioning the joint, and producing an analgesic effect. Hyaluronic acid injections were approved in the United States in 1997 for osteoarthritis of the knee joint when more conservative treatments have failed.  There are several brands of Hyaluronic acid injections approved in the United States and they include: Euflexxa, Hyalgan, Synvisc, Supartz and Orthovisc.  These can come in one, three, or 5 injection series. How does it work? After injecting hyaluronic acid into the knee joint space, the chemical attaches to the cartilage cells (chondrocytes).  This chemical then binds other molecules and creates a negative charge and attracts water to the cells, which is responsible for cartilages resilience (its resistance to compression). How long does the procedure take? The injections take just a few minutes.  First the area is cleaned and prepped. Dr. Buechel uses a cold spray to numb the skin, followed by a local anesthetic injection with a thin needle.  Then the Hyaluronic acid is injected into the joint once the site is numb.  A Band-Aid is placed over the site and it is recommended that you reduce your activity level for a few days while icing the area a few times a day to aid in the inflammation reduction.  Two brands, Gel-One from Zimmer and Synvisc-One from Genzyme, come in a single shot preparation. Other brands also come in a 3 shot or 5 shot weekly preparations.  The multi-dose injections require weekly visits to complete the series of shots. How often can this procedure be done? For intra-articular knee joint injections, once every 6 months is commonly covered by insurance for knee joints that respond to this therapy. You may find considerable or complete relief for several months with this therapy.  Some people have shorter or longer benefit from each treatment.  More frequent injections can improve pain control and therefore function but are not covered by insurance more than every 6 months. What should you expect? The goal of hyaluronic acid injection therapy is to reduce pain and increase walking tolerance. Initial improvement may be seen within a few days but generally takes full effect by 6 weeks. For arthritic joints, this is a temporary pain reliever and may last many months in mild to moderate arthritis but may become decreasingly effective over time as the arthritis progresses.   Some patients do not respond positively to this therapy and find that it does not help with pain relief.  But, in those patients that it is effective, it can be repeated twice a year (every 6 months when covered by insurance) for as long as it is effective in controlling joint related pain.  This is a last option generally for people prior to undergoing surgery for their arthritis.