Synvisc One injections

[surfnazi]

Hi, I'm 45 years old and have had a knee arthroscopy on my left knee due to a complex radial tear at the body of the medial meniscus extending into the peripheral zone. Further radial tearing was identified at the posterior horn centrally. Plus a low grade chondral irregularity at the lateral weight bearing surface of the medial femoral condyle,  ( MRI Scan Report).
This was due to the ground I was walking on at a mine site giving way exposing a void(Cavity hole)which my right leg disappeared into, leaving my left leg and knee being rammed into the ground surface stopping once my crotch hit the ground surface on the edge of the cavity hole.
I had the arthroscopy on the 30/11/2010 and have done much rehabilitation with Hydro and gym exercises(3-5 times a week) but the left knee still has pain on the underside of the knee cap and inside area. Pain is at a level 3 and once being used(exercising,walking,bending) quickly raises to a level 6 pain in these areas.Also I have sharp stabbing pains on & off in the lower inside area to a pain level 8 enough to stop me in my tracks with no prior warning signs before this happens.Plus I have clicking and crunching in the same left knee, loud enough that people around me can clearly hear it crack.Resently the left knee has given way a number of times and seems to be becoming more frequent.
Specialists(2) have said no more can be done and the next option is a knee replacement but I'm too young for that as the replacement knee joint may only last 10-15 years,and I still have 20 years of my working life yet to go before retiring.
My employer is wanting me to return to work in the mine pit at present on uneven ground conditions.
1;Do you know if anyone has had Synvisc injections to help this kind of injury before and what were the results?
2;Is there some kind of test one can have before the injections to make sure there are no bad side affects?
3;Considering returning to the mine pit for work(with plenty of walking, bending,twisting on the knee) can Synvisc be used for the rest of my working without long term side affects?
4;Once you require futher injections over time, where does the previous injection/Synvisc end up in the body?
5;If I was required to take Synvisc injections for the next 20 years of my working life, is this a good idea?
6;Does Synvisc become less effective over time, as do pain killers?  

[Suzi20071]

Hi surf nazi, I am not a doctor, but I have had arthroscopic surgery twice on my rt knee and Synvisc injected in 3 injection rounds, I believe, 2 different times.  However..... I did not have the severity of problems after surgery that you have.  I just had recurring pain in the knee.  So far so good.  I have had no after effects and it has worked good.  I don't have quite the active lifestyle you have either.  But I was really impressed with results.  My next option is knee replacement also.  Good luck.  P.s.  You don't ever have to take any more after the first round if that workks for you, and if I'm not mistaken you are only allowed to take 2rounds at a time.

Suzi20071

[S. Kaul, MD]

Hi there!

Well, without an evaluation and knowing the exact procedure that was done for the injury and current relevant clinical details, it would be difficult to answer your questions
1. Synvisc One is an injection that may be given for chronic osteoarthritis and a few other conditions; however I am not sure if it would be beneficial in your case.
2. It usually does not have many side effects, however it does run the risk of an allergic reaction, particularly if one is allergic to bird, animal or poultry products. An allergy test may be done to check, though the test is not performed everywhere.
3. The decision to return to activities is best taken by your treating doctor.
4. Synvisc one is a biological product and gradually degraded by the body enzymes.
5. It is not practical to use Synvisc One for long term.
6. Synvisc One is not a pain killer. Relief from an injection would normally last just 4-8 months.
It would be best to discuss the appropriate management in detail with your treating orthopedician.
Hope this helps.

Take care!

[surfnazi]

Hi Suzi,
           Thanks for your reply, I'm disappointed the surgery on my left knee didn't fix the injury that I substained and the on going problems after the operation was done is a real hassle. No matter how much effort I put in with hydro exercises and strenght work in the gym.
           Even with having a Synvisc injection I don't think it's going to stop my knee from collasping/giving way on me when ever it wants to.Trying to strenghten the area around the knee, I'm still having problems each time when I'm reaching the 6,7,8 rep. out of 15 where the knee feels weak and sore then starts shaking when under pressure.This happens both with single leg exercises and both legs being used together.Even when walking around you know when it's time to sit down and give it a rest, before having another go.
          The stabbing pains on the lower inside of area of the left knee are very annoying because there's no indication before or when it's going to happen and catches me out every bloody time.
          It really sounds like I'll have to go back to the doctor armed with a heap of questions and another roll of the dice, before becoming a pin cushion and hanging on for the ride and see where it'll ends.....

        Thanks again,
                           Cheers,
                                     Surf Nazi           "GO HARD OR GO HOME'

[surfnazi]

Thanks Doc,
                  the way the doctor that does the injections said to me, that the more I worked my knee and the nature of my job that I may need further synvisc injections possiblly every 6 months. Which to me was quite concerning. Considering the fact a number of GPs and other professionals have said it's only a band aid really for my left knee.
             Which made me wonder, how much further damage I could be doing to my knee joint after having synvisc? and that my employer is wanting to become a shotfirer in the mine pit at an open cut mine site continually walking on rough and uneven ground conditions. This alone seems to be quite mad and ludicrous due to their own policy of "Duty of Care" to it's employees.
            Your the first person that's said it's not a good idea for long term use,because the medicos are saying that I may need the Synvisc injections and possible pain killers to get me through the work day.My rostered shift is 12 hours a day for 14 days then 7 days off R&R. I don't like taking pain killers because you can't feel how much it's hurting until the effects of the pain killers wear off. Which by then is too late...
           I realise the taking of pain killers is not the answer ,and may also cause damage if used long term...
           I'm running out of options to fix my knee and not very happy about it. Trying to stay positive but not getting the results I'm looking for...

         Thanks for the guidance,

               Cheers ,
                            Surf Nazi                   "GO HARD OR GO HOME"      

[S. Kaul, MD]

Hi there!

Meniscal injuries may not have a favourable prognosis even with repair due to increased wear and tear and increased chance of developing degenerative arthritis and is worse for central tears.  Recovery largely depends on the severity of the injury and the rehabilitation schedule followed by the patient and may vary individually. If suggested by your doctor you could take Synvisc One a few times to help improve your symptoms, but getting shots every 6 months for the next 20 years may not sound like a practical idea. At this time I would suggest seeking an opinion from your treating doctor regarding the expected prognosis in your case, the activity level and any further management that may be required.
Hope this is useful.

Take care!