Inflammatory Reaction After Hylan
G-F 20 Injection That Mimicked Infection
Case Report
Salman Aljilani; Sarah Endrizzi
INTRO
•Inflammatory reaction after viscosupplementation of the knee is an uncommon but known complication of this procedure that can also mimic infection of the knee.
•Since septic arthritis of the knee is a potentially life threatening complication, it is important to be able to recognize the distinguishing characteristics between an inflammatory reaction of the knee and this more dangerous outcome.
CASE REPORT
•67 year old female with chronic bilateral knee pain received the second of three bilateral intra-articular hylan G-F 20 injections of the knees, and reported increased bilateral knee pain for the following two days that was worse than her pre-injection pain, with associated knee swelling.
•Patient denied fever, chills, recent infection, recent trauma, increased warmth or skin changes of the knees. As a result of these complications, a decision was made to cancel the third injection in the series.
•Patient’s third injection of the series was cancelled, the treatment plan was changed to receive intra-articular knee steroid injections, and patient subsequently responded well with significant pain relief.
DISCUSSION
•Of the various types of injectable Hyaluronic Acid, hylan G-F 20, a polymer of Hyaluronic Acid, has been identified in the literature to be the most common type that causes an inflammatory reaction that can mimic infection.
•Key features of this case that are characteristic features of an inflammatory reaction following viscosupplementation with hylan G-F 20 include:
1.) Intra-articular knee effusion with severe pain that usually occurs within 24 to 72 hours after injection
2.) absence of infectious signs/ symptoms including fevers, chills, or infectious source
3.) reaction must occur after the second or third injection in order for immune sensitization to occur that leads to the reaction.
