Knee Effusions as a Complication of Hyaluronic Injections: A Case Series

Abstract

HylanG-F20 (Synvisc) viscosupplementation is a relatively new medical intervention used in the treatment of osteoarthritis of the knees. There has been some controversy as to the frequency of local reaction secondary to the instillation of this material. A retrospective review of all patients who underwent hylan injection at Geisinger Medical Center revealed 16 out of 332 patients as having an acute local reaction thus indicating a 4.8% incidence of hylan flare. Acute localized pain, swelling and effusion characterized this reaction which generally occurred within 24 hours of hylanG-F20 injection. Arthrocentesis revealed a sterile effusion without microcrystals in all 16 of the knee flares and with a low to moderate leukocyte count of 87-9550 in 12 out of the 16 patients. The acute local reaction resolved with only conservative care (nonsteroidal anti-inflammatory drugs (NSAIDs) and ice or arthrocentesis followed by intra-articular steroids). Our case series supports prior studies that have reported the incidence of acute local reactions at approximately 5%. The cause of this reaction remains unclear.

Key Words::

• synvisc
• hylan
• viscosupplementation
• adverse effects