Synvisc injections for osteoarthritis in knee

[Sparrish]

I’m looking for advice from the members of this forum with medical backgrounds:

I'm just getting back into hiking and backpacking again after 2 surgeries on my left knee in three years (didn't hike at all for about 6 months-no backpacking for about 1 year--very depressing ) and the left knee is hurting once more after 1 backpack and 1 day-hike-fishing trip. I went to my Dr. yesterday (Saul Schreiber) for another check-up and he showed me the pics from the latest scope that indicated the remaining meniscus is rough and kind of shredded-wheat-looking.
Dr. S. said that right now is about as good as it will get and he also said that I am a good candidate for Synvisc injections into the knee joint. As I understand from the brochure, this is made from a substance (from rooster combs?) that is similar to the synovial fluid found in healthy joints and it provides a cushion and lubricates the joint much like the knee of a healthy 18-27 year old. The treatment consists of 3 injections into the joint over a three-week period and I could expect anywhere from 6 months to 1 year of pain-free comfort and a return to normal activity, including an active lifestyle of hiking and backpacking.
I got on-line last night and checked out some forums and the people that have had the injections report anywhere from 6 months to 2 years of relief. There were no negative posts.
The only caveat to this treatment is possible allergies to bird or egg products and I have no history of any allergy to such things. The brochure does contain somewhat standard warnings of possible side effects, up to and including anaphylactic shock due to an allergic reaction--in which case I would vamoose my butt down to John C Lincoln for a great big shot of adrenaline.

If anyone has any experience with Synvisc or has any input at all regarding this matter I would be forever grateful for your advice/comments/suggestions—except the one to stop hiking .

Best Regards,

Scott
_________________
“And all her face was honey to my mouth,
And all her body pasture to mine eyes;”
--A. C. Swinburne

[DesertDog]

I've got no experience with this drug (or any medical treatment for my worn knees, for that matter), but if you can't find any documented negative experiences, why not give it a shot (sorry)?

I've yet to degrade my knees to the point of surgery, but a year & 1/2 ago, I was wearing twin dual-strap Cho-Pats and using a hiking pole to get up & down Piestewa in an hour and a half.
I've been able to build up my legs so that I no longer use the supports or pole, and can get up and down in under an hour. I'm sure the increased muscle is compensating for the joint wear.

There is probably a good chance that if this drug will alleviate acute pain and lubricate the joint, you'll be able to do the same.

I was fortunate enough to avoid reconstructive shoulder surgery by building up the muscle while undergoing cortisone injections- I'm thinking you perhaps may be able to experience similar results- I know, in at least some circumstance, it can be done.

Good luck!

[Sparrish]

Thanks DD, I told him to go ahead with the approval (thru BC/BS) process and get it scheduled cause I figure it can only get worse by doing nothing.
And I'm also thinking how attractive I'll be to the ladies after I acquire the left knee of an 18-27 year old. I just hope I don't have to give it back before I wrinkle it.
_________________
“And all her face was honey to my mouth,
And all her body pasture to mine eyes;”
--A. C. Swinburne

[Andy]

I hate to be negative, However this treatment didn't do my wife any good! she tried it last year and it didn't help. She eventually had a total knee replacement and that was what she needed. She is getting around very well now!
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http://community.webshots.com/album/136917818udlQWZ

[Nighthiker]

What about a replacement meniscus ? They have them now and they are reportdly last between 5 and 7 years.

[Sparrish]

[GeorgAz]

I have gas 3 knee surgerires, one acl, and 2 scopes. I have never had Synvisc, but my neighbor has done it and it did help, but took some time to do so...she is now back to jogging and suffers very minmal pain. My Doc.( Dr Richard Emerson,) was always in the forefront of new procedures and he studied cartilage and meniscus replacement;.I understand that these procedures do work, healing and rehab time is more lenghty, but seems to be worth it. I stand for a living and my knees do swell sometimes and ache slightly, but I'll live with it...ski season will be here soon! The body parts do come back to get you sometimes! Good luck.

[Sparrish]

Thank you to all who have responded.
I have contacted Dr's office and left message that I would like to consult re meniscus transplant therapy. I did some cursory research this morning on the internet and it does seem to be a viable alternative, however, I do not know what criteria are used to determine siutabilty for transplant. I guess I'll find out and maybe try the Synvisc first if that's what is recommended.
_________________
“And all her face was honey to my mouth,
And all her body pasture to mine eyes;”
--A. C. Swinburne

[Trishness]

Scott,

I work for a large orthopedic practice in Mesa and they give Synvisc injections all the time. I'd say the majority of our patients have good-excellent results with this procedure. You are correct, it is given in a series of three injections, usually one week apart. Synvisc is usually given when there is no response to cortisone injections, or if there is evidence of bone to bone OA (osteoarthritis). You mentioned the meniscus is kind of shredded looking......did your physician mention if it is torn or partially torn and could be repaired arthroscopically or were your previous knee surgeries for meniscal repair?

Just a warning though. Not sure what your insurance is but it would be prudent to check with them to make sure there are no prerequisites for the Synvisc injections. Some insurance companies require prior authorization and some require that you try alternate therapies first, i.e. cortisone injections and/or anti-inflammatories before they authorize Synvisc.

Hope this info helps and good luck


_________________
~~~Trish~~~

"Eastward the dawn rose, ridge behind ridge into the morning, and vanished out of eyesight into guess; it was no more than a glimmer blending with the hem of the sky, but it spoke to them, out of the memory and old tales, of the high and distant mountains." � J.R.R. Tolkien, The Lord of The Rings.

[Sparrish]

Trishness:

I just had an arthroscopy 4 months ago (second time same knee) and the pain increased as I elevated my activity level. I followed the Dr's orders to the T, no hiking for at least 90 days and I performed all the excercises and even had lots of "pool time" where I did range of motion and light kicking and paddling. I really took it easy and slow. I also purchased a knee-brace from Sports Authority that has stays down either side for lateral support and velcro straps for transverse support. I use this brace when I hike.
The pain is different than the sharp, specific pain prior to the operation. There is a general dull ache that moves from outside left to inside right, under the front bottom of the kneecap back to the front top and then back to the outside left sometimes all at once but mostly throughout the course of the day, but never in any specific sequence. It seems very random.
I still have some healthy meniscus, but I do have a rough spot that he could not smooth out.
His office is checking to see if I have to have a cortisone injection first, but he said he doubted they would ask for it. I am currently taking 800 mg Ibuprofen x3/day, followed by tylenol #3, PRN (but not at work as my job involves heavy equipment). I will not move forward until I have a clear satement from BCBS that they will pony up the do-ra-mi.
I called the office today and left a voice mail asking for a consult on meniscus transplant.
Do you have any opinion on transplants? Is Synvisc something I should try first before considering a transplant? Got any spare knees lying around the office?

Thanks for your time and concern,
The Gimp
_________________
“And all her face was honey to my mouth,
And all her body pasture to mine eyes;”
--A. C. Swinburne

[Trishness]

Scott,

The meniscus transplants (also called an "allograft") have been done by my docs with good results. It all depends on your situation and your best bet is to talk to your MD about ALL your options. Synvisc injections can be done in the office and are far less invasive than either TKR or allograft which are open procedures and will require a longer recovery time. So you might want to try those first but still be faced with the prospect of surgery down the road.

No spare knees hanging around my office....sorry. Got a nice left hip though.
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~~~Trish~~~

"Eastward the dawn rose, ridge behind ridge into the morning, and vanished out of eyesight into guess; it was no more than a glimmer blending with the hem of the sky, but it spoke to them, out of the memory and old tales, of the high and distant mountains." � J.R.R. Tolkien, The Lord of The Rings.

[CatValet]

If you need a second opinion I suggest Dr. Angelo Mattalino, scottsdale.

[Sparrish]

Thanks Trish and CV, I'm going to try the injections first and see what results.
Trish--can transplants be done via a scope?
_________________
“And all her face was honey to my mouth,
And all her body pasture to mine eyes;”
--A. C. Swinburne

[Sparrish]

I had the first shot of “chicken juice” afternoon and it went well. A little pain afterwards but it subsided after a few hours and I woke this morning with no swelling or redness. In fact, it feels pretty good.
However, as the dawn approaches, I do have this strange urge to leap onto the top of the fence and belt out a few "cock-a-doodle-doos" and I just ate a bug off the floor.
_________________
“And all her face was honey to my mouth,
And all her body pasture to mine eyes;”
--A. C. Swinburne

[Hikngrl]

Suz isn't gonna be happy if you start eating all of her bugs!
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~~~Diane~~~

I want to shine!