This treatment for painful joints may offer alternative to invasive surgery

Tracy Woolrich's picture
Rooster Comb omjections may be an alternative to knee replacements.

Rooster comb injections could become a great alternative to costly and invasive knee replacements.


What do painful joints and rooster combs have in common? More than you might realize with rooster comb injections on the rise. It is thought that the injections could become a great alternative to costly and invasive knee replacements. But are they for you?

Osteoarthritis is a condition that affects more than 20 million of Americans. It is usually first diagnosed during the baby boomer ages. It can however be seen also in younger patients with prior joint injuries or who are overweight.

It is difficult for me to think of rooster comb treatments without envisioning Foghorn Leghorn from Looney Tunes and Merrie Melodies. However for those who are suffering in pain this is not a laughing matter.

Treatment options
The routine medical treatment calls for weight management, tailored exercises, anti inflammatory medications (either orally or by injection) and cold pack applications.

For those who do not respond to these treatments, the non surgical option of injections of joint lubricants may be worth while. This is a type of treatment that was originally derived from rooster combs and is widely used by orthopedic surgeons as well as rheumatologists.

The main component of this injection is hyaluronic acid. This specific acid may:

  • Increase the viscosity of synovial fluid
  • Increase in visco-elasticity of synovial fluid
  • Reduce the degradation of cartilage and the lining of the joint
  • Analgesic effect
  • Reduce inflammation

A study was done using patients from a large orthopedic practice. The study occurred over a six-year period of time and evaluated the possibility of delaying total knee replacement surgery. The investigation involved more than 860 patients that all had grade 4 (bone on bone) knee deterioration. The conclusion was that using a lubricant (for this study it was Synvisc) delayed surgery 2-3 years.
(Waddell DD, et al. Journal of Managed Care Pharmacy; March 2007, Vol. 13, No. 2, Pg 113-121).


In February 2011, WPTV News Channel 5, the NBC affiliate in West Palm Beach, aired a spot discussing the use of Synvisc injections, which is one of 5 types of joint lubricant injections currently available. Watch the video here.

Brands of joint lubricants
Not all injections are made the same. Nor are they administered in the same way. Orthovisc, Synvisc and Euflexxa are given as 3 injections one week apart. Hyalgan and Supartz treatment comprises of 5 injections one week apart. According to product inserts the pain relief varies from 12 weeks for Euflexxa and up to 26 weeks for the others.

Side effects

  • Injection site pain/edema
  • Joint swelling
  • Generalized joint pains
  • Pseudoseptic joint
  • Gastrointestinal complaints


  • Patients with known hypersensitivity to hyaluronic acid products
  • Injection through an inflamed area of skin
  • Patients who have an allergy to bird proteins, feathers, or egg products.

Euflexxa which is synthesized in a different manner can be given to those with these allergies

Joints shown to be effectively treated

  • Knee
  • Hip
  • Shoulder
  • Ankle
  • Jaw (TMJ)
  • Base of the thumb (CMC)

Take home message:
If you are considering having a knee replacement, ask your doctor if the rooster comb injections therapy is right for you.

If you have severe OA, injections might not be right for you due to the amount of damage that may have already occurred.

If you have known allergies to eggs or birds, your doctor might recommend you undergo a Euflexxa injections as it is the only lubricant that is not made from a bird source.

American Journal of Sports Medicine