Board Certified, New York City Based, Osteopath Specializing in Spine, Pain and Sports Medicine
Viscosupplementation – Gel Shots
What is viscosupplementation or “gel shots?”
Gel shots, or viscosupplementation, is most commonly used for knee pain secondary to arthritic change that has not been sufficiently responsive to physical therapy and/or medication. (Medical necessity statement)
Osteoarthritis is the most common form of arthritis that often affects the knee. Osteoarthritis is a condition in which the cartilage around the joint wears down and can’t protect the bones that make up the joint. In osteoarthritis, loss of the joint synovial fluid contributes to joint pain and stiffness. Synovial fluid is a naturally occurring substance found within the joints to act as a lubricant to enable bones to move smoothly over each other and as a shock absorber. Gel shots, or viscosupplementation, is where a gel-like fluid called hyaluronic acid (HA) is injected into your joint to act as synovial fluid. Injecting “gel shots” to the damaged, arthritic joint can help facilitate movement and reduce pain. Pain reduction can last up to 6 months.
What are the differences between gel shots and corticosteroid shots?
Corticosteroid, or steroid injections, are another treatment option recommended by the American College of Rheumatology to improve joint function. These injections include corticosteroid medication and a local anesthetic. They are most effective in treating inflammatory conditions, such as rheumatoid arthritis, bursitis, gout, plantar fasciitis, psoriatic arthritis, reactive arthritis.
Corticosteroids sometimes also referred to as cortisone injections can help relieve pain and reduce inflammation in the body including ankle, elbow, hip, knee, shoulder, spine, and wrist. Like “gel shots”, steroids are injected directly into the joint space and can reduce pain more quickly.
Steroid injections will provide more immediate relief from pain with a faster recovery, but the relief will be more short term.
Steroid treatment is used with caution for diabetes because steroids can raise blood sugar levels. Additionally, there could be an adverse effect of this treatment for prolonged use and to those allergic to corticosteroids. In these instances, viscosupplementation may offer an alternative treatment for joint pain relief.
How do you prepare for a gel shot?
It is best to prepare for the treatment by discussing your symptoms and severity of your joint pain with your doctor. There should be clear communication speaking about the procedure and what to expect. Prior to the appointment day, you will have discussed with your physician any specifics you have about the injections.
Gel shots are usually recommended for patients when less invasive treatment options have not provided relief. Gel shot injections can be administered within a standard doctor’s office visit.
How is the gel shot procedure performed and what can you expect during your office visit?
During the procedure, you will be positioned in such a way that the affected joint is easily accessible. After the area around your joint is sterilized, a small amount of joint fluid will be removed before the actual injection to make room for the hyaluronic fluid.
We will use ultrasound imaging guidance to help localize and place the medication. By providing the gel shots to a region the medication has the potential to act as a shock absorber or lubricant. You may experience some pressure or slight discomfort. A small bandage will be placed over the injection site. You may receive a single treatment or weekly treatment for 3 to 5 weeks depending on the product used.
What is the follow-up and recovery like for a procedure?
Your knee may feel tender for a few days after the procedure. For the first 48 hours after the injection, avoid excessive weight bearing on the leg, such as standing for long periods, jogging or heavy lifting. This is to reduce the risk of post-treatment flair.
Depending on your condition we may also suggest driving restrictions. Ice can be used to soothe your joints during the recovery process.
What are the potential costs for a procedure?
Depending on your insurance coverage, many insurances cover the cost, or a portion, of the procedure. Learn more about our insurance participation.
What are the potential risks for a viscosupplementation procedure?
The most common side effect includes pain at the injection site, swelling, heat, redness, bruising. This can be treated with ice. Inflammation may occur after gel injection, though the symptoms are typically mild and temporary. For this reason, restricted activity is recommended for 48 hours after the treatment.
The most severe risks are infection and bleeding. The treatment is contraindicated in patients with hypersensitivity (allergy) to sodium hyaluronate preparations and patients with known infections or skin diseases in and around the injection site.
Are gel shots a treatment option for osteoarthritis?
For the treatment of osteoarthritis, the non-invasive options may include physical therapy and non-steroidal anti-inflammatory drugs. Corticosteroid injections and viscosupplementation injections (gel shots) are recommended if first-line therapy does not work.