What is this I hear about using some type of "rooster comb" to inject into the knee joints for arthritis? Stan Osteoarthritis (degenerative joint disease), also"wear and tear" arthritis, is common in the knees of the middle aged and older, perhaps millions of people world wide. The normally smooth, shiny cartilage surfaces of the joint start to wear and also there is a compromise of the normal lubricating joint fluid.

The process you are referring to, which is called viscosupplementation, involves injecting hyaluronic acid to act as a lubricant in the joint. This is a natural occurring substance found in normal joint fluid. The early form of the drug was actually manufactured from rooster combs; hence the layman's term. Much of it now is synthetically manufactured.

Viscosupplementation has gained popularity in the recent years for use in patients not responding to other conservative treatments for osteoarthritis of the knees. This has been used in Europe for many years before FDA approval in the United States for knees only. The reported results are mixed. It seems that in about 2/3 to 75% of carefully chosen patients there is a significant reduction in knee joint pain and swelling which may last for several months. The treatment would then have to be repeated. It seems to be less effective in more advanced arthritis or arthritis in combination with a significant deformity such as "bowed legs". This treatment is not indicated for other types of arthritis, such as rheumatoid arthritis.

The typical application involves three shots over a couple of weeks. Typically, the shot only takes a couple of minutes. The injection area is sterilized and then a local anesthetic is used. A needle is inserted into the knee joint and any excess fluid is removed before injection of the medication. There may be a mild local reaction afterwards and typically it is recommended that you ice and elevate that night and take it easy for a day or two after injection. There is typically no significant short term pain relief. Within three or four weeks, you may find that there is improvement in the overall knee pain. This could last for several months. "Rooster comb" injections, or viscosupplementation, is not for everybody with knee osteoarthritis. However, it may be a useful adjunct for your conservative (nonoperative) care.

David W. Shenton, MD