The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Injections into the joint => Topic started by: JOW_103 on January 11, 2013, 09:00:39 PM

Title: Synvisc One & Euflexxa ... question
Post by: JOW_103 on January 11, 2013, 09:00:39 PM
This is my second post to the board.  Over the summer I had a round of three Euflexxa injections along with a cortisone shot.  Within three weeks of the last injection along with the cortisone the knee pain I had was back.

I went back to my OS who recommended a Vision Scope (needle arthroscopy) which I had back on December 14.  He confirmed I have grade 4 focal changes to my medial tibial plateau and recommended a PKR and referred me to another OS.

The new OS advised against this (too young and active) and has recommended trying a Synvisc One injection and if that doesn't work then an HTO. 

Has anyone had Euflexxa not work for them and then tried Synvisc One and gotten a good result?  Curious as to whether or not the product makes a difference or if it doesn't work for one,  then it won't work for all visco injections.

Thanks for your comments
Title: Re: Synvisc One & Euflexxa ... question
Post by: JOW_103 on January 28, 2013, 10:39:08 PM
I just thought I would share what I have learned.  I found Genzeyme's documentation on this injection.  According to their data, people with Grade 4 OA have about a 58% chance of getting any benefit from this shot.  Here's a link if you want to see what they say: ( 

Not holding out too much hope in getting relief with this course of treatment.  Not to mention it's been very difficult to get the prescription filled through my insurance.  Been almost a full month and still haven't gotten the speciality pharmacy to ship the stuff to my ortho.
Title: Re: Synvisc One & Euflexxa ... question
Post by: JOW_103 on February 02, 2013, 06:20:39 AM
Well after wrangling with the specialty pharmacy for over a month I was finally able to get my Synvisc  One syringes delivered to my OS.  I was supposed to have only 1 shot but the pharmacy messed up and sent two syringes.  I ended up getting shots in both my knees as both are and have been painful to walk on.

When I was leaving the doctor's office, started getting really lightheaded all of a sudden.  I went back to the doctor's office and they put me on a gurney for 30 minutes or so until my head cleared.  I've never had a reaction to getting a shot like that before.  Anyway after abut 30 minutes everything was fine and I drove myself home.

So far the knee is a little sore and there appears to be some slight swelling of the knee.  No pain or burning in the leg or swelling of the legs as some others on the board had reported.  Pain is still there but we'll see in a few weeks if I get any relief.  OS said that most people start to see improvement in abut 4 weeks time and at worst 6 weeks.  If I don't feel anything different after 6 weeks, OS said to call him and we'd discuss surgical options.  He thinks HTO might be in order.   Time will tell.

Title: Re: Synvisc One & Euflexxa ... question
Post by: JOW_103 on February 12, 2013, 05:43:13 AM
I figured i would post back my progress from the recent Synvisc One injections I had.  It;s now been 1 week and 3 days since I had the injections done.  My feeling is I have had minimal to no real relief from the OA pain I have had for more than a year.

Sometimes my knees feel almost normal when I walk, but it's not long after that the pain comes back.

Sunday I had a presentation to do for an event I am running.  I was on my feet off and on for a 6 hour period.  By the time it was over, my knees were so sore I could barely walk.  I came home and tried to take a short nap but my knees were so painful I could never get comfortable. 

I am not really sure how my knees should feel after the Synvisc One injections.  Should I be 100% pain free or should I just see a reduction in the intensity of the pain.  I will post back in another week or so and let people know how it's working for me.  It can take 4 weeks or longer for the injections to reach their maximum effectiveness.  I guess it's too early to tell if they've helped or not but my confidence in them is not very high.
Title: Re: Synvisc One & Euflexxa ... question
Post by: greatfulgann on February 12, 2013, 02:00:39 PM
I had Synvisc One and it eliminated the crunching I was feeling.  It still hasnt returned and its been 6 weeks.  I had no negative effects from this shot.  My OS did remove some synovial fluid prior to my injection so I never had feelings of fullness, swelling or any discomfort.  If my other knee acts up I would consider this shot on that knee as well.   
Title: Re: Synvisc One & Euflexxa ... question
Post by: Vickster on February 15, 2013, 07:27:26 PM
I had a Durolane jab during arthroscopy and then 3 jabs of Ostenil about 15 months later as I was experiencing pain and stiffness - this was 7 months ago and my knee is doing pretty well.  No bony deterioration on X ray.  I think the jabs take a good 6 weeks to take effect, but when used in the correct indications, my OS said the benefits can last 2+ years

I would say 10 days is too early to be able to tell really.  Give it time, although it does depend on the state of the knee.  They are not an alternative to a TKR according to my specialist

Title: Re: Synvisc One & Euflexxa ... question
Post by: teacher ted on February 18, 2013, 05:57:57 PM
Well, I've had three Synvisc (the original three shot ones and then two One's) in both knees for OA (I was 50-52 yo at the time, I'm 54 and can't really  say that they helped as OA goes through good and bad stretches lasting a week or more for both of my knees.  My new OA (reportedly the guru for Maine) told me to stop, he said that the long term effect of HLA is unknown.

I'm going to see him in a couple of days to either do two TKR's or perhaps look into stem cell shots. Those are getting rave reviews but aren't FDA approved yet.
Title: Re: Synvisc One & Euflexxa ... question
Post by: JOW_103 on February 19, 2013, 08:48:50 PM
@vickster - My left knee has Grade 3 and Grade 4 OA confirmed through a needle arthroscope procedure in December.  In January 2012 I had meniscus surgery to repair a tear.  My reason for being less optimistic on them working is having gone through the 3 Euflexxa injections early this year with no effect at all.  Also, the OS who did the needle arthroscope, recommended a PKR and not the injections or another arthroscopic procedure to clean up the cartilage.  It was that OS who recommended my current OS, however, this new guy wants to take a more conservative approach to my knee problems.

Also, since both SynviscOne and Euflexxa are both classified as visco supplements I'm not sure why one would work over another as they basically are intended to do the same thing.

I'm also not sure how my knees should feel after the injections.  Should I simply feel a reduction in the discomfort or should I be totally pain free.   From where I'm standing, the pain levels are about the same.  I guess I'll know more in a couple of weeks.  Perhaps you could comment on how you felt after the injections.

@teacher ted - Thanks for the reply.  I am 51 and still active.  I think my experience so far is more in line with what you felt.  Sometimes knees feel better but in less than a few hours or days the pain is just as bad as it was prior to the injections.  Particularly when I have to be on my feet for long periods of time.  Was bartending Friday night and by the time my shift was over I could barely stand or walk.  I was even using the anti-fatigue mats as well.  Went home, iced the knees and take a Vicodin to get some relief for the pain.
Title: Re: Synvisc One & Euflexxa ... question
Post by: Vickster on February 19, 2013, 09:03:15 PM
My knee feels less stiff, less burny, less sore going downstairs, generally calmer :)

I can't imagine with any degree of grade 4 damage that you will be pan free in all that you do, just potentially more comfortable, especially at rest.  Depending on where the joint is damaged (which you don't say), loading it could potentially cause pain.  The cartilage itself has no nerve endings etc but the bones below do I believe.

Muscle strengthening, weight loss, avoiding anything that aggravates the knees (be it walking, stairs, standing, running, kneeling) and painkillers could all help,  My OS said that the jabs are not a substitute for replacements if such is indicated

Are you taking any sort of supplements - although there isn't much documented and proven evidence - cod liver oil, chondroitin, glucosamine can be helpful

I am sure different people will react differently to the different HA formulations, although I think I read that they are only effective in around 1 in 2 (possibly as they are not used in the correct indications).  My OS said that they have been used for 10+ years, were used a lot in the US in all sorts of indications and he was very sceptical.  He has been using for around 4 years and has seen good results but he is selective in the patients he gives them to

Hope it all goes well for you
Title: Re: Synvisc One & Euflexxa ... question
Post by: JOW_103 on February 20, 2013, 04:59:57 AM
@vickster -  Thanks for answering my follow up questions.  My OA is confined to the medial part of knees.  I am slightly bowlegged and the OA said I am putting 80 - 90% of my weight on the medial portion of the knee.  According to the OS who did the needle scope, he said there were grade 4 focal changes to the medial tibial plateau.  The lateral and patella areas are largely intact.  Although when I had my meniscus repair last January the OS did cleanup the cartilage underneath the knee cap on top of the femur

As far as what I am experiencing, my knees always seem to be stiff and do hurt when I go up/down stairs.  Particularly if I am carrying anything in my arms.  When I sit for a while and then get up, the stiffness is always there and I do get that burning pain sensation from time to time when I am sitting or when I am driving.  I also feel pain when I walk and my knees tend to catch and pop on my once in a while. 

I did speak to my OS about losing weight, he said if I did that it would help but I am not grossly overweight so he didn't think it would make a huge difference.  I do manage to get to the gym two - three times a week and do fifteen minutes on an elliptical machine as well as a 30 minute weight training session.  I also play recreational ice hockey once a week and don't have any problems skating. 

In my research I did find that SynviscOne is only 58% effective in patients with Grade 4 OA.  Because of how I felt prior to the injections and how I feel almost 3 weeks after the injections I do not see a big benefit from it.  Just doing the daily things in life are causing pain so I feel an HTO is probably in order.  I know I'm tired of hurting all the time and I just want to go back to feeling somewhat normal again.
Title: Re: Synvisc One & Euflexxa ... question
Post by: SallyW on February 21, 2013, 12:34:33 AM
I am grade 4 in the patella compartment; I have less damage (grade 3, I think) in the medial. I had 3 shots of Euflexxa last month; my doctor was not optimistic that they would help, but he said it was my best option until I have time for a TKR later this year.

He used an ultrasound machine to help with needle placement for the last two injections. They hurt less that way because he was able to place the needles more precisely, he was also able to get the medication exactly where it was most needed.

It's been about 6 weeks since the first injection. My knee hurts some, especially if I'm overactive. But I'm comfortable most of the time, and only occasionally need one of my prescription NSAIDs for relief. Before the injections, I was experiencing severe pain all day, even with every NSAID at my disposal. I was also icing almost constantly.

My doctor warned me that the treatment will likely wear off before my TKR; he told me that at that point I should expect to spend a lot of time icing my knee and wearing one of my many knee braces. I guess I'll deal with that when it happens. But right now - yeah, the injections were worth it for me. I really need to be as active and comfortable as possible until I have surgery, so the injections are helping with that.
Title: Re: Synvisc One & Euflexxa ... question
Post by: JOW_103 on February 21, 2013, 05:40:57 PM
@SallyW - Glad to hear the Eufelxxa worked for you.  I didn't have any luck with it all and so far the SynviscOne isn't really doing much.  I am staying active despite the painful knees.  I'm hoping that in six weeks without much effect from the SynviscOne the OS will look at surgical options.  At my first consult he talked about HTO as an option as opposed to PKR.  All I know is I'm ready to move on from the pain.
Title: Re: Synvisc One & Euflexxa ... question
Post by: JOW_103 on February 27, 2013, 08:26:43 PM
It's now four weeks post injection.  I've noticed that when I am not very active the knees feel pretty good when I walk. There is still pain there but not as bad as before the injection.  I still have the stiffness like always and when I am active or stand on my feet the pain gets considerably worse. 

Last night I was standing for about 15 minutes and by the time I was finished what I was doing my knees felt terrible.  I also noticed I can't really walk that much before the knees become painful.  A recent trip around the grocery store was excruciating.

So far I would say the I got a minimal amount of relief from the Synvisc One injections but not to where I would say I would rate them a success.
Title: Re: Synvisc One & Euflexxa ... question
Post by: Vickster on February 27, 2013, 08:33:27 PM
Good to hear you are getting some relief so soon, still early days.  My surgeon told me that in his experience, where successful, the effect of these injections can last 2+ years

Hopefully, you won't need any surgery for a long time going forwards :)
Title: Re: Synvisc One & Euflexxa ... question
Post by: JOW_103 on February 28, 2013, 03:40:20 AM
@vickster - Actually in a couple of weeks I am going to go back to the surgeon and come up with a different plan. He told me the shots can take 4 weeks to become effective and it may take as long as 5-6. 

Right now I would say that daily living is a chore and the injections haven't done much to alleviate the pain in my knees.  If I sit around and don't do anything they feel fine for the most part, however the minute I am active the pain comes right back.  I have a hard time navigating stairs particularly when carrying things, can't walk around a grocery store or walk around the shopping mall without sitting constantly because the pain becomes so bad.

The injections are supposed to help you remain active and I understand that if they work you can get up to 6 months of pain relief.  I don't think sitting around watching TV is considered being active.  I'm tired of the conservative treatment and want some real relief. It's been 18 months like this and I've had enough.  I don't want to rush into surgery but I'm I really want to feel better sooner than later.
Title: Re: Synvisc One & Euflexxa ... question
Post by: Vickster on February 28, 2013, 08:21:23 AM
It's always interesting to hear how different surgeons have different experiences with the same treatment - as said, mine has patients who get 2 years relief, but then he is very selective about where he uses HA - I don't think in extensive OA.  He says it is not an alternative to TKR and that also probably means osteotomy.  If a big surgery is warranted, it makes sense that a conservative treatment is less likely to succeed.  In my view, always exhaust the conservative first - I had surgery for tennis elbow last November, but not until I had tried lots of physio, a support, taping, acupuncture, steroid and PRP!

All the best for whatever you and your surgeon decide  :)
Title: Re: Synvisc One & Euflexxa ... question
Post by: JOW_103 on March 05, 2013, 08:10:27 PM
Well I have reached the proverbial end of my rope.  I worked as the show manager at the facility my fraternal organization owns over the weekend.  After about 20 minutes of standing on my feet I couldn't stand it anymore.  Walking and just standing was extremely painful.  When I sat down for 15 - 20 minutes the pain would subside but as soon as I started walking again it came right back.  I worked both Saturday and Sunday with the same results.

Earlier in the week I was standing in my kitchen folding some letters, after about 15 minutes I had to sit down because my knees got very painful again. 

I have made an appointment with my OS for next Wednesday to discuss other options. 

My feeling is the injection did help with the day to day pain felt while just walking.  I seem to have a dull pain but better than what I was feeling prior to the injection.  However, if I walk or stand for a short period of time (15 mins. or longer) the pain get's worse. The only way to get rid of it is to sit for a long time and let it go away.  Even 800 MG prescription Motrin won't dull the pain I feel and I never seemed to get rid of the stiffness I feel in my knees either. 

Would I recommend Synvisc One.  Probably as it does help with the day to day walking and if effective can provide up to 6 months of relief.  I think the more active you are the less likely it is to help and the type and grade of OA impacts it's effectiveness as well.

For me I would say it did not work because doing daily living tasks (grocery shopping, walking around the mall, working) it didn't help.  All I know is I'm tired of feeling this way and am looking forward to another more effective treatment option whatever that might be.
Title: Re: Synvisc One & Euflexxa ... question
Post by: Vickster on March 05, 2013, 08:13:44 PM
Might be worth discussing an unloader brace given your arthritis is confined to one compartment - not to use all the time, just when you think you may need it

Or there are surgical options of course, if you feel ready and you have confidence in your surgeon's recommendations.  There are some excellent articles in the information hub on osteotomy, replacements etc

Good luck :)
Title: Re: Synvisc One & Euflexxa ... question
Post by: JOW_103 on March 06, 2013, 03:22:08 AM
@Vickster I actually have an unloader brace.  I got it right when I started my Euflexxa injections over the summer.  I wore it for two straight weeks and found it really didn't help with the pain.  I have also worn it when I know I am going to be on my feet for long periods.  It doesn't seem to really do to much.

I mentioned this to the OS when I first met him.  He said that my knee ligaments are very tight and so the 3% of offset that the brace provides isn't enough to make a difference. 

I honestly think my best options are PKR or HTO.  It's going to come doe to what the OS thinks is best and how much activity I want to lose if I get a PKR vs. HTO.
Title: Re: Synvisc One & Euflexxa ... question
Post by: JOW_103 on March 08, 2013, 06:52:04 PM
Just came back from my consult with the OS.  After looking ate the latest x-rays and discussing the  options we have decided that a PKR is in order. Because of my age and activity level he didn't think the HTO would provide enough pain relief.  My surgery is scheduled for April 1st.

He also said my right is too far gone for an HTO or PKR so I am headed for a TKR in that knee at some point down the road.

Not really looking forward to the surgery but am glad that there is some light at the end of this tunnel.  I will be creating my surgical diary on the board so others may learn from my experiences.