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  • Writer's picturePasadena Orthopedics, Inc.

Injections for Ankle Arthritis

Supartz Injection




About Osteoarthritis (OA)

Osteoarthritis is a degenerative disease that can affect any joint in the body. For us, that includes the ankle joint, foot joints, and even toe joints. Being the most common form of arthritis, osteoarthritis affects millions of people around the world. Individuals in their mid-to-late forties tend to have a higher risk of developing osteoarthrosis. Physiologically, osteoarthritis is resulted from the stress on the joint, repetitive movements and wear and tear. The damaged cartilage in the joint will cause inflammation and pain. At the same time, it restricts the range of motion in the joints. Being a progressive condition, the symptoms of osteoarthritis tend to worsen over time. As the condition deteriorates, patients may find it hard to climb stairs, walk, or even stand. Thankfully, there are many treatment options for osteoarthritis, including prescription medications, steroid injections, custom molded orthotics, physical therapy, and lifestyle modification (e.g. weight reduction). Apart from that, viscosupplementation injectables such as Supartz or Synvisc are also used as for the symptomatic treatment of osteoarthritis.


As we get older, our joint fluid levels decrease, which can lead to joint pain. Fluid loss can also be caused by Osteoarthritis, which will not get better without treatment. While conservative treatments are the mainstay of treatment for osteoarthritis, they may not work on all patients. For patients who have not had success with these treatments, doctors may utilize viscosupplementation, as second-line treatment. Viscosupplementation is a treatment that has a cushioning effect on the joint.


Supartz is a viscosupplementation injectable commonly used in the management of osteoarthritis pain. Supartz is an injectable, which contains fluid with a gel consistency. Supartz is a synthetic fluid designed to match the fluids that surround joints in the body. The fluid within joints helps to absorb shock and keep the joints lubricated. Having shock-absorbing properties, the gel-like fluid allows smooth movements between the bones.


Supartz is formulated with hyaluronic acid (hylan G-F 20 and sodium hyaluronate), a compound that mimics the actions of a natural substance in the joint. It lubricates the joint, helping the bones to move smoothly. As a result, pain can be significantly reduced, and patient joint mobility is improved.

The injections are performed at our office by Dr. John. Using a needle, the Supartz injection is injected into the affected joint space. It typically takes a few minutes to complete the procedure. The duration of action can be lasting for approximately 6 months but can vary from patient to patient.


As with all viscosupplementation injectables, Supartz is designed for symptomatic treatment, meaning this is not meant for patients who do not have joint-related pain of the Foot or Ankle. They do not cure the underlying causes of osteoarthritis, nor do they regenerate the injured or degraded cartilage.


Who Should NOT Have A Supartz Injection?

Supartz is sourced from rooster combs; therefore, they should NOT be used in those with a known allergy to avian (bird) proteins, poultry, feathers, and/or egg products.

Anyone who has previously had any previous allergic reactions to Supartz therapy or similar material (hyaluronate products) should NOT have a Supartz Foot or Ankle joint injection.

Anyone with infections or skin diseases around the Foot or Ankle area should NOT have a Supartz Foot or Ankle injection.

If you are pregnant or lactating, we DON’T recommend that you have a Supartz Foot or Ankle injection, because its safety in pregnant/lactating women has never been studied.

You should also inform us if you have any blood clots or circulation problems in the legs.

Supartz has not been approved for use on anyone under the age of 21.


How Many Supartz Injections Do I Need?

Supartz injection treatment is FDA approved for 5 weekly knee injections, but some patients report benefit from only 3 injections. (Some patients may experience benefits with as few as 3 injections given at weekly intervals. This has been noted in a study in which patients treated with 3 injections were evaluated for 90 days.) The number of required injections can vary in Foot and Ankle conditions when compared to the knee.

Dr. John believes the best protocol for Foot or Ankle injections is to perform a series of 3 weekly injections and then wait 4-6 weeks before determining whether or not you should have two additional injections. This protocol seems to provide the highest value for patients.


Post-Supartz Injection – After Care Recommendations

After receiving an injection, let the area rest for the next 48 hours. Try not to stand for longer than one hour at a time, and be sure to avoid strenuous activities such as running, jogging, or lifting weights.


What Are The Side Effects Of Supartz?

After injection, patients may experience temporary pain and swelling at the site of injection. However, these symptoms tend to be short-lived and self-limiting in nature.

The largest clinical trial injections involved a series of 5 knee injections. The pain was the most common side-effect. 18.4% of Supartz injection patients reported pain as did 16% of control patients. Another common side-effect was arthralgia (defined as joint pain with no evidence of inflammation). This occurred in 12.6% of Supartz recipients and 15% of controls.

Other reported side effects include:

  • Back pain: 11.5% of Supartz recipients, 12.5% of controls.

  • Headache: 3.4% of Supartz recipients, 5% of controls.

  • Injection site pain: 3.4% of Supartz recipients, 5% of controls.

  • Injection site reaction: 1.1% of Supartz recipients, 3.8% of controls.

In Summary

The progression of Ankle, Foot, and Toe osteoarthritis can lead to the inability to walk, stand, or even develop difficulty wearing shoes. This can significantly disrupt the daily functioning of patients. Current treatment modalities often can be used to manage the condition. Unfortunately, they do not always work. Being the second-line treatment of osteoarthritis, viscosupplements such as Supartz effectively reduce pain, providing lasting symptomatic relief. While there is currently no cure for osteoarthritis, it is possible to relieve its associated symptoms and slow the progression of the disease.


Supartz vs. Synvisc: how are they similar and different?

Both Supartz and Synvisc are formulated with hyaluronic acid (or more specifically, hylan G-F 20 and sodium hyaluronate), a compound that mimics the actions of a natural substance in the joint. Having similar modes of action, they lubricate the joints, helping the bones to move smoothly. This subsequently reduces discomfort and pain. Supartz and Synvisc also have a similar duration of action, lasting for approximately 6 months. Synvisc seems to have equivalent efficacy to Supartz (neither of the injections is more superior to the other). Perhaps the biggest difference between the two formulations is number of injections required. Supartz is usually given in 3 to 5 injections consecutively. In contrast, Synvisc is typically given in 3 separate injections.


What are the side effects of Synvisc and Supartz?

Both Synvisc and Supartz have a similar side effect profile. After injection, patients may experience temporary pain and swelling at the site of injection. However, these symptoms tend to be short lived and self-limiting in nature. Synvisc and Supartz are sourced from rooster combs; therefore, they should not be used in those with a known allergy to avian proteins, feathers, and/or egg products.


The takeaway

The progression of ankle, foot, and toe osteoarthritis can lead to the inability to walk, stand, or even develop difficulty wearing shoes. This can significantly disrupt the daily functioning of patients. Current treatment modalities often can be used to manage the condition. Unfortunately, they do not always work. Being the second line treatment of osteoarthritis, viscosupplements such as Supartz and Synvisc effectively reduce pain, providing long lasting symptomatic relief. Supartz and Synvisc are equally effective in the symptomatic treatment of osteoarthritis. While there is currently no cure for osteoarthritis, it is possible to relieve its associated symptoms and slow the progression of the disease.


If you would like to see if you are a good candidate for these injections, please call Pasadena Orthopedics and schedule an appointment with board-certified Foot & Ankle surgeon, Dr. Sara Shirazi --- 626-517-0022.

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