Hyaluronic acid - brand differences?

[Vickster]

I had a Durolane injection during my second scope in December 2010 which seemed to help the knee settle and heal.  Over the last few months, the knee has been tender and stiff and a couple of KGers have suggested I get an HA top up    This seems a sensible plan, especially as I have lots of long haul travel and long working hours sitting ahead of me (which will also impact my ability to cycle my usual 50-100 miles a week).  Assuming my private insurance will cover, I will be able to see the OS of choice. 

My first OS is 5 minutes up the road, and although I need to confirm, I think Synvisc is his poison of choice.  To see the second OS who gave me the Durolane will take me half a day as he's 50+ miles away the other side of London.  At the moment, with work commitments, I really don't have time to get there - he also tends to be rather more booked up than the other surgeon.  I have no preference either way as to which chap to see, they are both excellent.  I need it done in the next week or so as I am off to Brazil in the 3rd week of May and need the knee settled for traipsing around, 11 hour flights and long days of sitting.

My question is, ultimately, is there any difference between the different types in terms of efficacy (I work for the pharma industry so I am sure there are some differences but when all is said and done, this is the same naturally occurring stuff).   I have no allergies.

Be very grateful for anyone's input, perhaps having had different brands.  Many thanks

[Vickster]

Local OS now uses a different brand, Ostenil, starting a course of 3 jabs on Thursday.  We discussed the single jab version, but he says the stuff is very thick and viscous and very painful when injected.

My private insurance company has agreed to pay for a single 3 jab course, here's hoping it helps 

[garethday]

i am looking into having ostenil aswell.  would love to hear your experiences with it!


Gareth

[Vickster]

I'll post back after the injection(s).  I expect they are going to be uncomfortable, a nice big needle apparently - just as well they don't bother me! 

[Vickster]

First Ostenil jab done about 2 hours ago.  Took about 2 minutes, quick swab, jab to lateral side (4 inch needle perhaps, fairly fine), barely felt it, plaster applied to be kept on for 12 hours.  Knee feels a bit puffy, stiff, heavy, but then it often does.  No local anaesthetic or anything like that.

I don't expect much effect from the first injection, next one in 9 days.  All good 

[LindaM]

Good luck with the injections.  I had a single Synvisc which didn't work, but that was because my OS, my rheumatologist and I all thought I was having a severe flare when I was probably already bone-on-bone.  From those who have success (hopefully you ) I have heard that it can easily take up to a month for you to notice a really significant difference, so hang in there!  You are a recovery in process!

Linda

[Vickster]

Cheers Linda

I had the second jab this morning - it was far more painful than the first - I wasn't very relaxed (stressful long week of work and I have a cold  ) - and contracted my patella, so the OS managed to hit the bone and then inject into the fat ...  OUCH    Not had a good knee week so here's hoping for a good result with this jab (and the next one in 2 weeks) . 

We had a bit of a discussion about next steps if this doesn't work well - OS says no point waiting any longer to try to fix the defect and he'd want to try a repair ... so fingers crossed for the jabs - I do not want a big surgery if at all possible and I will totally slammed with work and long haul travel  until at least October! 

[LindaM]

Hey Vickster,

Sorry to hear you second round was painful after already having a tough week.  I know how unappealing that plan B discussion is.  My thumbs are bone-on-bone and the right has been bad the last month.  Monday it hurt to have my jacket sleeve brush the thumb and I finally gave in and called for a cortisone shot.  I got it Tuesday morning(my rheumatologist is awesome-he made an extra 7:15 A.M. appointment to fit me in) and we had the chat about plan B.  After having my knee done in February I really don't want to have another surgery any time soon.  Hopefully the cortisone will get it calmed down-the last shot lasted almost a year.  And hopefully you Synvisc will kick in soon and do the same.

Linda 

[seerobinbike]

Hey, there you are Vicks.!  Oh, and howdy to Linda as well!   Sorry that your thumbs are giving you so much grief.

Ouch.  That second shot sounded extremely painful Vicks.  I hope that it's working as well!  I don't get it.  You were doing so well with the biking and all.  Our knees are so fickle. Hope that you are feeling some relief by the time you read this.  I know it does take a while.  Are you still riding or have you been too busy with work?  All that sitting and flying around the world can't be helping your knee.  I'm surprised to read that there is a possibility of another surgery in your future.  Oh, I hope not as well!  Fingers crossed that this post finds you and your knee much happier and less painful.

Robin

[dm]

I've just had my third Hyalgan shot.. eeoww! ... these shots are painful.  I think they deliberately designed the stuff to be like gear oil for vehicles. And, they stick like 5cc of the stuff in there to boot! They've been using about a 12ga needle (that's what it looks like to me) and the hole left behind is sure big enough for it to be that big. I've not had any pain relief so far from the shots - when I see how the knee feels 2-3 days after the shot. The only thing I've noted so far is an increase in crepitus  - the rice crispies have brought friends to stay - it crackles even more that I notice - and it seems to "clunk" even more loudly in the two spots it has been catching the worst, and a zero decrease in pain levels.

These shots are my last ditch effort to put off a TKR - my last scope (#6) was to deal with a partial acl tear that was repaired, two torn meniscus, and an ocd lesion to my femur. It took 18 months for the ocd lesion to fill in via microfracture, and the acl was repaired and that failed 14 mos later so my knee's as loose as you can imagine. and I've got grade 3/4 articular cartilage damage in my patellofemoral compartment and most of my medial meniscus is gone. new os says my medial side is shot and pkr isn't an option.

[LindaM]

Hi there,
Sorry to hear that the third injection wasn't like the first.  I have been without Internet on vacation in Florida so haven't responded.  Hopefully you are having some relief by now.  If you are so loose it would make sense that with the space more open with extra fluid things would move more.  I agree, another surgery so soon would stink.  Here's hoping that your knee strata to improve soon.

Linda