Importance of placement of knee injection needle!

Question

Have heard that injecting a jelly/gel like material into the knee relieves pain in knee arthritis. Are these injections painful? Some people do get reactions, swelling, pain after such injections. Do such reactions occur due to incorrect placement of needles of injection? What is the criteria for the doctor? Does a doctor have to have experience to put the injection in the right place, how does he confirm the placement?

Answer

You are referring to injections of hyaluronic acid into the knees for osteoarthritis. The trade names are Synvisc, Hyalgan and Supartz. Hyaluronic acid is part of the normal joint lubricant and these products are synthetic versions isolated from the combs of roosters. The exact mechanism of how they work is unclear. Supartz and Hyalgan require 5 weekly injections; Synvisc 3. Inflammatory reactions to the material can occur with swelling and pain. These are fairly rare, and slighty more common with Synvisc than the others. The injections may take up to 3 months to take effect. My personal opinion is that these agents provide modest benefit and tend to work better in patients with some cartilage left rather than on patients with “bone on bone” damage on x-ray.

Yes, I think it would be less painful to have an experienced physician do the injections.

Alan Matsumoto, M.D.

About Alan Matsumoto, M.D.

Part-time Faculty, Division of Rheumatology
Johns Hopkins University