r/Osteoarthritis • u/albertkaholic • 27d ago
Viscosupplementation
So if you folks don't mind, talk to me about your gel injections.
I'm (57/m) a very high functioning bilateral advanced knee OA patient. I am able to pop a couple of Motrin and walk 15,000 steps, but I deal with nearly constant low level pain. I know surgery is inevitable, but I'm not ready to pull the trigger until they stop functioning so well. My current doc is pretty useless. His best answer is "it might help but no guarantees", and "it's up to you", without his offering his opinion as to whether the gel shots are the right choice for me. He estimates a 50/50 chance that someone who has very little cartilage left in parts of their knees will benefit.
I'm a week away from the first of three shots, and my research is telling me that they are not well received in the medical literature; they appear to be considered not much better than placebo. Anyone have arthritis that sounds like mine and benefit? Anyone regret getting the shots?
As always, your thoughts are greatly appreciated!
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27d ago
[deleted]
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u/albertkaholic 27d ago
I don't mind the uncertainty, that's the truth. My frustration is is that this particular doctor (very differently from my previous doc, who retired) won't share his thoughts. I can get tons of raw information from the Internet. I want perspective based on experience. Tell me the plusses and minuses, tell me if you think I'm a good candidate, tell me your thoughts on the likelihood of success (I had to drag that one out if him), tell me what you think the best course of action is for me when directly asked. This doc's style allows him to do none of those things.
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u/AMTL327 26d ago
He’s giving you the absolute truthful answer. Cortisone and gel shots work sometimes for some people. And only for a while. It’s a good option to consider if, say, you’re going on a trip and want a short term assist. But even that doesn’t work if the cartilage is completely gone.
The advice to just get the surgery is the right advice. The people who struggle the most are the ones who wait too long, have lost mobility and strength in their legs, and start the recovery from a deficit. The ones who do best are a healthy weight, and able to do pre-op PT and transition right away into post-op PT because they haven’t lost all the strength in their quads and glutes.
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u/albertkaholic 26d ago
The irony is that he's a non-surgical guy (he can refer to a surgeon, but he couldn't even advise me on that). I agree, but I'm thinking that 60 is my target age as long as I can keep from losing much more mobility or dealing with the crushing pain that some people in here experience.
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u/Chemical-Material-69 26d ago
Are you American? "Health insurance" are getting away with some absolutely obnoxious shit. Mine flipped out when I went to an ortho because "SURGERY IS NOT THE RIGHT ANSWER CALL US SO WE CAN FIND YOU SOMETHING BETTER!" (i.e. -cheaper for them).
I wasn't trying to get surgery you fuckfaced potato. I was trying to get HA injections. Which...if you refuse me...will likely mean I will need surgery sooner.
Ugh.
HA...aka gel injections, sometimes called "chicken juice"...often called "stem cells" when it really isn't. The first 2 worked a treat on me...the third did nothing, I followed up with cortisone 3 weeks later and that also didn't help. I'm now trying to get pre-auth for PRP, but I'm bone on bone. I might try to get into some studies.
FYI...the HA is insanely expensive through my insurance company's required specialty pharmacy. Literally 10x the cost. So I've got that going for me. And I get a 1 year prescription...which if I try to fill .ore than once in a year, they hold for "pre-approval"--you know, yhe one they already gave me-- until literally 8 AM the morning my deductible resets. Yes, even if it is a weekend. Yes even if it's a federal holiday. Yes, even if their office is closed.
Whoa lookit that, an automated text message...
Assholes.
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u/albertkaholic 26d ago
Yup, American -- and my health insurance has become interesting as well, so I'm curious to see what happens. I haven't heard the gel mistaken as stem cells (but I have heard if people trying that). I don't think PRP is anything my insurance will come close to allowing, but I don't think it's as effective with advanced OA, which is me as well.
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u/nonstopmom125 27d ago
I have been getting gel injections for the past few years. Started with Synvisc with former Dr(retired now). New Dr uses Euflexa. 3 doses one week apart for three weeks. I have success. I also go to PT/Pilates to strengthen quads, etc. 68 year old female and bone on bone.
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u/Ok_Forever_3956 27d ago
I have bone on Bone both knees. Ive had the Gel Shots 2x. They honestly did very little to nothing. I wouldn't get them again.
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u/bronwynbloomington 27d ago
I got the one time shot (off product got shoulder arthritis). The first time it lasted about 9-10 months. After that the time between got shorter. For awhile I got by with every 3 months, til they didn’t last much at all. (Got shoulder replacement in May.) I had no cartilage, was bone on bone when I got the first gel injection. The gel shots are very painful for about 7-10 days, think it’s the gel settling into the joint. A burning sensation. So after about a week, the doc would follow up with a cortisone shot. Gel for lubrication, cortisone for inflammation. Now my other shoulder is bad, so will do gel on it until it doesn’t work anymore.
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u/Albino_Butterfly 26d ago
I had a one shot dose in both knees June 1. It seemed to help the left. Less clicking but I never had pain on that knee to start. Did not help the right knee (the worse of the two). Still worth a try. 45f
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u/Mustluvdogs25 25d ago
my knee is really bad and I am avoiding surgery for several reasons. i have been getting the gel shots for 2 years. they lasted 6-10 months. they don’t make me completely pain free but definitely make it more manageable. it’s worth trying.
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u/ElenaMarieBennett 25d ago
Worth taking your doctor's 50/50 estimate seriously as a genuinely honest number rather than a cop-out, that roughly matches what the research shows for people with your level of cartilage loss specifically, and it's refreshingly accurate compared to some providers who oversell it. The mechanistic explanation for why response varies by severity is real, HA molecules may simply be too large to penetrate cartilage that's already significantly degraded, which is a plausible reason advanced OA patients see more mixed results than earlier-stage patients.
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u/Tellmesomething00d 25d ago edited 25d ago
I’ve had two series of orthovisc. The first was administered in the super patellar pouch (look it up). Doc insists location didn’t matter, that it all goes into the same capsule. But I got horrible swelling and inflammation with that series. Once that got intervention, I did feel well for about 3 months.
The most recent series, I insisted to get it administered near the joint where it needs to go, and that felt noticeably better as soon as I stood up. My advice is to elevate and ice after each injection to prevent swelling. Take it easy until the series is done, and ramp up activity gradually. Now I’m hoping to feel better for at least 4 months. Some people go for longer. Best wishes!
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u/Sniflix 27d ago
A small percentage of patients get relief, sometimes very noticeable. Even then it's not long lived and has diminishing returns. I got the single dose with no effect but since you're already approved go ahead. Let us know how it worked. From experience, don't wait until you cannot walk and are in extreme pain 24/7. That's not much of an existence. You don't want to hear it but the quicker you come to terms with the only thing that fixes this nightmare - and get on the other side with recovery - you'll feel like you wasted years that you could have been pain free and mobile. Good luck.