Who Is a Candidate for Viscosupplementation? Eligibility Guide

Are You a Candidate for Viscosupplementation?

Viscosupplementation isn’t right for everyone, but for the right candidates, it can provide significant, lasting relief from osteoarthritis pain. This guide will help you understand if you might benefit from this treatment.

Ideal Candidates

You may be a good candidate for viscosupplementation if you have:

1. Mild to Moderate Knee Osteoarthritis

Viscosupplementation works best when there’s still some healthy cartilage remaining in your knee. Doctors use the Kellgren-Lawrence grading system to assess osteoarthritis severity:

2. Failed Conservative Treatments

Most insurance plans (including Medicare) require that you’ve tried and failed other treatments first, typically including:

• Physical therapy for at least 6 weeks
• Over-the-counter pain relievers (acetaminophen, NSAIDs)
• Lifestyle modifications (weight loss, activity changes)
• Assistive devices (knee braces, walking aids)

3. Desire to Avoid or Delay Surgery

Viscosupplementation is an excellent option if you:

• Want to postpone knee replacement surgery
• Are not a good surgical candidate due to age or health conditions
• Prefer a non-surgical approach to pain management

4. Active Lifestyle Goals

The best candidates are typically those who want to:

• Return to activities like walking, golfing, or gardening
• Maintain independence in daily activities
• Reduce reliance on pain medications

Who May NOT Be a Good Candidate

Viscosupplementation may not be appropriate if you have:

Medical Contraindications

• Active joint infection or skin infection near the injection site
• Known allergy to hyaluronic acid or avian products (for bird-derived brands)
• Bleeding disorders or taking blood thinners (relative contraindication)
• Pregnant or breastfeeding (safety not established)

Conditions That May Limit Effectiveness

• Severe (Grade 4) osteoarthritis with bone-on-bone contact
• Significant joint deformity or malalignment
• Inflammatory arthritis (rheumatoid arthritis, gout)
• Large knee effusion (significant joint swelling)

Age Considerations

Younger Patients (Under 55)

• May benefit from viscosupplementation to delay surgery
• Important to address underlying causes (weight, activity modification)
• May need repeated treatments over many years

Middle-Aged Patients (55-75)

• Often the ideal age group for viscosupplementation
• Can provide years of relief before considering surgery
• Medicare coverage begins at 65

Older Patients (75+)

• Still effective for appropriate candidates
• May help avoid surgical risks associated with age
• Consider overall health and activity goals

What Your Doctor Will Evaluate

Before recommending viscosupplementation, your doctor will typically assess:

1. Physical Examination

• Range of motion in your knee
• Areas of tenderness or swelling
• Joint stability and alignment
• Gait analysis (how you walk)

2. Imaging Studies

• X-rays to assess cartilage loss and bone changes
• MRI may be ordered to evaluate cartilage condition in detail

3. Medical History

• Previous treatments and their effectiveness
• Other health conditions that might affect treatment
• Current medications
• Allergies (especially to bird products)

4. Treatment Goals

• What activities do you want to return to?
• How much pain are you currently experiencing?
• What are your expectations for treatment?

Insurance & Medicare Requirements

Medicare Coverage Criteria

For Medicare to cover viscosupplementation, you typically need:

1. Documented diagnosis of knee osteoarthritis
2. Failed conservative treatment (usually 6+ weeks)
3. X-ray evidence of osteoarthritis
4. Treatment by qualified provider

Private Insurance

Requirements vary by plan but often include:

• Prior authorization requirement
• Documentation of failed conservative care
• Specific brand preferences
• Limits on frequency of treatment

Self-Assessment Questions

Consider these questions to help determine if you might be a candidate:

Your Symptoms:

• Do you have knee pain that limits your daily activities?
• Does your knee feel stiff, especially in the morning?
• Have you noticed your knee pain getting worse over time?

Your Treatment History:

• Have you tried physical therapy without adequate relief?
• Do you take pain medications regularly for your knee?
• Have other treatments (cortisone shots, braces) provided only temporary relief?

Your Goals:

• Do you want to stay active and independent?
• Are you hoping to avoid or delay knee surgery?
• Would you like to reduce your reliance on pain medications?

If you answered “yes” to several of these questions, viscosupplementation may be worth discussing with your doctor.

Next Steps

If you think you might be a candidate for viscosupplementation:

1. Schedule an evaluation with an orthopedic specialist or pain management physician
2. Bring your records including previous X-rays and treatment history
3. Prepare questions about the procedure, expected outcomes, and costs
4. Check your insurance coverage and any prior authorization requirements

Frequently Asked Questions

Can I get viscosupplementation if I’ve had cortisone shots?

Yes. Many patients transition from cortisone to hyaluronic acid injections. You may need to wait 2-4 weeks after a cortisone shot before receiving HA.

What if I have arthritis in both knees?

Both knees can be treated, though your doctor may recommend treating them at different times to monitor your response.

How do I know which HA brand is right for me?

Your doctor will consider factors like your schedule (single vs. multiple injections), any allergies (avian vs. non-avian source), and insurance coverage. Compare all HA brands

What if viscosupplementation doesn’t work for me?

If you don’t experience adequate relief, your doctor may recommend other options including different HA brands, PRP therapy, or surgical consultation.

Take our Viscosupplementation Assessment to see if you might be a candidate, or learn how viscosupplementation works.