HAppyvisc®

A viscosupplementation involves an injection into a joint (most often the knee, sometimes the hip, shoulder, ankle, hand…) of a pre-filled syringe of hyaluronic acid. For some products it may be necessary to repeat the injection over 3 consecutive weeks.

The patient lies on the examination couch. The doctor carefully disinfects the area to be injected and, under sterile conditions, inserts a needle into the joint, sometimes using radio or ultrasound guidance.

He then withdraws the excess synovial fluid and slowly injects the viscosupplement into the joint. After removing the needle he gently mobilizes the joint to distribute the product throughout the joint and then places a dressing on the injection site.

Usually the interval between two injections is about 1 year. However it can vary greatly (from 6 months to several years) depending on the viscosupplement used and the severity of osteoarthritis. In severe osteoarthritis it is sometimes necessary to repeat an injection every 6 months.

Only physicians are authorized to perform intra-articular hyaluronic acid injections.

As it is important to master the injection technique, they are in the vast majority of cases performed by rheumatologists, orthopedic surgeons, rehabilitation specialists and sports medicine doctors.

If the needle passing through the skin may be painful for a few seconds, the injection itself is usually painless. A painful injection requires repositioning the needle correctly before continuing the injection.

The patient lies on the examination couch. The doctor carefully disinfects the area to be injected and, under sterile conditions, inserts a needle into the joint, sometimes using radio or ultrasound guidance.

He then withdraws the excess synovial fluid and slowly injects the viscosupplement into the joint. After removing the needle he gently mobilizes the joint to distribute the product throughout the joint and then places a dressing on the injection site.

As after any infiltration, a relative rest of 24 hours is recommended. However this does not prevent moving for usual daily activities, while avoiding heavy exertion, prolonged standing and of course sport. It is generally recommended to suspend sports for 4 or 5 days.

It is perfectly possible to walk after a knee infiltration. However it is strongly recommended to limit walking to the strictly necessary, avoid stairs as much as possible, not run or perform lifting efforts for at least 24 hours. The duration of rest recommended by the doctor depends on each individual situation.

Viscosupplements based on hyaluronic acid differ considerably from one another. It is therefore absolutely wrong to say they are all equivalent. However it is not possible to rank viscosupplements. As with automobiles, there are high-end, mid-range and entry-level products with very different prices. In each category your doctor will choose the one that seems best suited to your case.

Treatment of osteoarthritis is based on a combination of medicinal and non-medicinal measures adapted to the type of osteoarthritis (knee, hip, hands, spine…), its severity and the characteristics of each patient (age, associated diseases, concomitant treatments).

The main medicinal treatments for osteoarthritis are analgesics, non-steroidal anti-inflammatory drugs, slow-acting symptomatic drugs, corticosteroid infiltrations and viscosupplementation with hyaluronic acid.

Scientific studies show that among the treatments for knee osteoarthritis, the most effective treatments are corticosteroid infiltrations and viscosupplementation with hyaluronic acid. The former are used for rapid relief of pain and inflammation. Hyaluronic acid has a less rapid but much more durable effect (on average 1 year) than corticosteroids whose effectiveness does not exceed 2 months.

The term viscosupplement is given to all hyaluronic acid solutions intended to be injected into a joint. Other products that can be injected intra-articularly (corticosteroids, platelet-rich plasma) are not viscosupplements, nor are hyaluronic acid solutions for dermatological or cosmetic use.

Among viscosupplements there is a very wide range of very different products, with very different clinical performances and characteristics.

The doctor in charge of viscosupplementation chooses the product best suited to each case, depending on the treated joint, the severity of osteoarthritis and the objectives he has previously agreed with the patient.

There is a wide range of viscosupplements with different origins, performances and durations of effectiveness, which explains price differences between products. To know the origin of the product (and not its French distributor) you should look for the small factory symbol usually found at the bottom of the leaflet, on the last page of the distributor's website or on the box.

Prices vary greatly (ranging from €50 to €200) and depend on many parameters. On the market we find viscosupplements up to 200 times more viscous and elastic than others. Some viscosupplements remain in the joint more than 10 times longer than others. These sophisticated products are obviously more expensive than basic, low-viscosity products that are rapidly eliminated from the joint.

Besides performance, the origin of hyaluronic acid (Asia, Europe, France) has a significant impact on price.

Cross-linked products, which are more viscoelastic and remain much longer in the joint, are also 2 to 3 times more expensive than their non-cross-linked competitors. As viscosupplements are not reimbursed by health insurance, their price is not fixed (only recommended) and can vary considerably between pharmacies.