What is osteoarthritis (OA)?

OA is a disease that affects the joints.

OA is the most common form of arthritis – 27 million people in the US are affected by OA. It usually begins after age 45 and is most common in people over age 65, but people in their 20s or 30s can get OA too. Overuse of the knee joint, job- or sports-related injuries, being overweight, and family history can all play a role in OA.

Learning more about OA can help you take control of your knee pain. This section provides information about OA, what causes it, and how to treat it.

If you have one or more of these symptoms in your knee, you may have OA:

  • Aches and pains, especially with motion
  • Stiffness, especially in the morning and when standing up
  • “Grating” or “catching” sensations
  • Limited motion
  • Swelling

Normally, smooth, firm tissue called cartilage covers and protects the ends of your bones. The fluid in the joint contains a substance called hyaluronate (hī-ə-ˈlūr-ə-ˌnāt), which acts as a “shock absorber” and lubricant so that the knee joint can work properly.

Risk Factors

  • Age
  • Obesity
  • Injury or overuse
  • Genetics or heredity
  • Muscle weakness
  • Other diseases and types
    of arthritis

When you have OA of the knee:

  • The joint fluid may lose its ability to protect the joint
  • Smooth cartilage that normally protects the ends of the knee bones may lose its cushioning effect or become pitted and frayed. Large areas of cartilage may even wear away completely, so the bones scrape painfully over each other
  • Cartilage breakdown may cause the joint to lose its shape, and the bone ends may thicken and form bony spurs
  • Fragments of bone or cartilage may float in the joint space, causing further damage and pain

There are a number of treatment options available for your osteoarthritis knee pain.

These include:

  • Physical therapy, exercise, and weight loss
  • Nonprescription pain relievers
  • Hyaluronate injections
  • Prescription medicines like Steroid injections
  • Platelet Rich Plasma (PRP) therapy
  • Prolotherapy ( injections of sugar water into the supporting structures of the knee which can be further researched on our website).
  • Coolief radiofrequency treatment ( which can be further researched on our website)
  • Knee surgery ( the last choice and only after doing other forms of treatments)

What to expect with your Viscosupplementation treatment

Viscosupplementation injections give you long-lasting relief of osteoarthritis knee pain

  • Can provide long-lasting pain relief for up to 6 months
  • Can be safely used for up to 30 months

Viscosupplementation is a safe choice

Gel injections are not a drug. Its principal component is a naturally derived substance called hyaluronan that relieves your pain by lubricating and cushioning your knee joint. Hyaluronan is a natural chemical found in the body and is present in a particularly high amount in joint tissues and in the fluid that fills the joint (also called synovial fluid). Viscosupplementation products are injected directly into the knee.

Viscosupplementation injections work differently than oral pain medications. They do not pass through your bloodstream to work. Because it is injected directly into your knee, it does not cause stomach bleeding problems like some pain medications.

  • Does not interfere with any other medicines you may be taking for osteoarthritis or other conditions
  • Has been shown to be safe for repeat treatment in a 30-month study

What is Guided Imaging and why is it so important in performing gel injections?

We use a special holographic fluoroscopic guided injection protocol that allows our doctors to see that the gel is getting to the right place. Blind injections can miss the joint about 35% of the time. We are 100% accurate with our injections which gives you the confidence of getting the best recovery possible.


  • When is viscosupplementation the right choice for me?
  • Who should not receive viscosupplementation ?
  • How soon will I get pain relief?
  • How long will the pain relief last?
  • Can I get pain relief without receiving the full amount of shots?
  • Will The injections be the only procedure needed to relieve my pain?
  • What are the most common side effects from the injetions?
  • Can treatment be repeated?
  • Can viscosupplementation make my knee work better

When is this program the right choice for me?

Gel injections is for the treatment of osteoarthritis knee pain, when simple painkillers or exercise are not enough. The treatment that’s right for you will depend on how far your osteoarthritis has progressed, how much pain you are experiencing, and what has worked (or not worked) for you in the past.

Who should not receive Gel injections?

  • Your health care provider will not administer gel injections if you have had any previous allergic reaction to any of the viscosupplementation products or similar material; ie, other Hyaluronate products
  • You should not have a gel injection into the knee if you have infections or skin diseases around the injection site
  • Consult our physicians if you are allergic to products from birds, such as feathers, eggs, and poultry

Your health care provider will review your medical history and examine your knee to determine if an injection may be safely given.

How soon will I get pain relief?

Pain relief varies from person to person and may depend on the severity of your pain. In medical studies, most patients noticed a difference within 1 week following the third injection. However, some patients did not get pain relief until after the 5 injections.

How long will pain relief treatment last?

Five injections given at weekly intervals can provide most patients with long-lasting pain relief for up to 6 months. The duration of pain relief you experience may vary. Physical therapy can increase the life of the gel injections by strengthening the support structures around the knee.

Can I get pain relief with fewer than 5 injections?

Some patients may experience benefit with 3 injections given at weekly intervals. This has been noted in studies of patients receiving 3 injections who were followed for 60 days.

Will treatment with gel injections be all that I need to relieve osteoarthritis knee pain?

Everybody responds differently to pain. In our facility we combine gel injections with physical therapy which has improved our outcomes. Patients have reported a difference when the physical therapy has been able to strengthen the knee weeks after the last injection was given. We have seen the best results when the physical therapy has been able to work when the knee has received a full complement of injections.

What are the most common side effects of treatment?

Side effects are seldom seen and when seen are pain, swelling, heat, and/or redness of the joint, as well as rash, itching, or bruising around the injection area. These reactions were generally mild and did not last long.

Can treatment be repeated?

Yes. gel injections have been shown to be safe for repeat treatment in a 30-month study. In medical studies, 1 cycle (5 injections) of gel injections provided pain relief for 6 months. Because osteoarthritis is a chronic and degenerative condition, you and your health care provider can decide when it’s time to repeat the treatment. You may have injections every 6 months according to Medicare

Can help my knee work better?

Osteoarthritis of the knee is a chronic and degenerative condition that has no cure, but the pain can be controlled. Treatment with gel injections can relieve the osteoarthritis knee pain that may be keeping you from doing the things you want to do.

Knee exercises:

Osteoarthritis knee exercises can be an effective treatment for your knee joint pain.

Exercise helps:

  • Keep joints flexible
  • Increase muscle strength
  • Control weight
  • Strengthen bones and ligaments
  • Improve mood and overall outlook

Before you start

Talk to our Physical Therapist or doctors before beginning any exercise program. It’s important to learn which osteoarthritis knee exercises are best for you, how to warm up safely, and if there are any joints you should not exercise.

General Tips

Get educated

Learn as much as you can about the disease. Investigate gel injections and join a water aerobics class, gentle exercise groups or other movement groups such as Tai Chi or Chi gong

Protect your joints

Avoid excess stress on your joints

Stay active

Regular physical activity is key. Consult with your health care provider before beginning any exercise program.

There are 3 types of exercise that we stress in our office through Physical Therapy that are important for people with osteoarthritis of the knee:

  • Strengthening exercises to increase muscle strength and help protect your joints
  • Aerobic exercise to improve the health of your heart and circulation and to control your weight
  • Range-of-motion exercises to help reduce stiffness and develop proper joint flexibility and movement

Eat well

Eating well and controlling your weight can relieve stress on your knees. It can also lower your risk of developing other health problems. We have specific diet consultants that work in our office to provide nutritional counseling, diet management to reduce inflammation and weight loss. Reduction of certain foods helps to reduce inflammation and swelling in the joints as well as reduction of pain. Ask for information on this program.

Indulge yourself

A warm bath before bed can relieve muscle tension, ease aching joints, and help you relax.

Get plenty of sleep

Sleep can lessen pain and help a good night’s sleep; you cope better with your osteoarthritis.

Tips to help improve your sleep include:

  • Getting enough exercise early in the day
  • Avoiding caffeine or alcohol at night
  • Keeping your bedroom dark, quiet, and cool

Stay positive

  • Focus on your strengths, not your weaknesses
  • Make fitness and good nutrition part of your lifestyle
  • Learn ways to manage stress
  • Develop a support system of family, friends, and healthcare providers