Cingal®

Osteoarthritis is the most common type of arthritis, affecting more Canadians than all other forms of arthritis combined. Osteoarthritis begins when the cartilage in a joint starts to wear away, leading to thinner and less healthy synovial fluid, exposed bone, and the development of bone spurs. This can cause pain, inflammation, and stiffness in the affected joint, making it difficult to perform everyday activities. These changes in the synovial fluid and degeneration of joint structures may lead to osteoarthritis knee pain.

Hyaluronic acid is a naturally occurring substance found in the synovial fluid of the knee joint. When you have osteoarthritis, there may not be enough natural hyaluronic acid in the joint, and the quality of that hyaluronic acid may be poorer than normal. Injecting hyaluronic acid into the joint, a procedure known as viscosupplementation can help reduce pain by lubricating the cartilage.

Combination viscosupplementation and corticosteroid Injections

A corticosteroid and viscosupplementation combination treatment like Cingal® is a single intra-articular injection that provides the quick knee pain relief of a corticosteroid with the long-term knee pain relief of a viscosupplement. As the only combination treatment of its kind, Cingal® offers the convenience of both treatments in one. This treatment offers effective pain relief for up to 6 months, making it a popular choice among those who are looking for a longer-lasting solution. If you’re struggling with knee pain caused by arthritis, Cingal® may be the ideal treatment option to consider. Book a consultation to determine whether this treatment is right for you.

Planning Your Treatment

Patients are encouraged to self-refer (i.e. a referral from your family doctor is NOT required). However, you should be assessed initially by a GP and have a provisional diagnosis. Also, x-rays are required prior to the consultation with Dr. Fisher. The purpose of the consultation with Dr. Fisher is to determine if private therapeutic injections would be appropriate for you (not to diagnose the condition).

Once you have a provisional diagnosis and xrays, we will schedule a consultation with Dr. Fisher, where he will review your history, do a focused sports medicine physical exam, review your imaging, discuss your diagnosis, outline the pros and cons of the various injections, and recommend the most appropriate injection therapy based on your individual needs and preferences. Please be sure to bring any imaging reports that you have (e.g. x-rays, ultrasounds, MRI, MRA, CT scans) to the consultation. Depending on your specific situation, Dr. Fisher will either perform the ultrasound-guided injection at that time, or we will schedule a future appointment for the injection (and for subsequent injections, if necessary).

Before the Treatment

Depending on the specific injection therapy selected for you, Dr. Fisher may advise you to stop taking certain medications or supplements prior to the procedure (e.g.  such as blood thinners or anti-inflammatories). You should wear loose, comfortable clothing that allows easy access to the injection site, such as shorts for lower extremity concerns or a tank top or sports bra (for women) for upper extremity concerns.

During the Treatment

You will be placed in a comfortable position while the affected area is cleaned. Local anaesthetic will be provided if necessary. Dr. Fisher will then use the ultrasound machine to guide the needle to the correct location, ensuring accurate placement of the injection. The injection itself typically takes only a few minutes, after which the needle is removed and a small bandage is applied to the site.

All of our musculoskeletal injection techniques are done by Dr Fisher using ultrasound to guide to location of the injections. There are many advantages of using ultrasound to guide therapeutic injections:

Ultrasound Guided

1. Increased Accuracy: Ultrasound allows Dr Fisher to have real-time visualization of the targeted area, which helps ensure accurate needle placement. This means that the injectable solution is more likely to be delivered precisely where it is needed, improving the effectiveness of the injection.
   
   
2. Reduced Pain: When injections are given blindly, there is a risk of hitting nerves or other sensitive structures, which can cause pain. Ultrasound-guided injections can help reduce pain by allowing Dr. Fisher to avoid these sensitive areas.
   
   
3. Improved Safety: Ultrasound-guided injections are generally considered safer than blind injections because Dr. Fisher can visualize the needle as it is inserted and ensure that it is placed in the correct location.
   
   
4. Increased Patient Satisfaction: Patients who receive ultrasound-guided injections often report higher levels of satisfaction because the procedure is less painful and more effective.

After the Treatment

Dr. Fisher may advise you to rest the affected area and avoid strenuous activity for a certain period of time. You may also be advised to avoid certain medications for a specific length of time. Dr. Fisher will review your specific post-injection recommendations to ensure optimal results.

Recovery

Recovery from a therapeutic injection for musculoskeletal pain can vary depending on the type of injection and your individual response. In general, you may experience some mild discomfort or swelling at the injection site for a few days after the procedure. For some types of injections, such as hyaluronic acid and cortisone, it may take several weeks and/or multiple injections to see the full benefits of the treatment.

Lubricant and anti-inflammatory properties working together

Over time, the composition of synovial fluid and wear and tear on joint structures can result in knee pain from osteoarthritis. Cingal® is a single-injection treatment that combines the lubricating properties of hyaluronic acid with the anti-inflammatory effects of corticosteroids (cortisone).

Hyaluronic acid

A healthy knee joint contains hyaluronic acid in its synovial fluid, which helps lubricate the joint and protect its cartilage. Viscosupplementation, which involves injecting hyaluronic acid into the joint, is believed to provide long-term pain relief by enhancing cartilage lubrication, similar to how oil lubricates an engine. However, its effects may take some time to appear.

Corticosteroids

Corticosteroids, such as cortisone, have anti-inflammatory properties and can offer fast pain relief by reducing joint swelling.

The combination of hyaluronic acid and corticosteroids in Cingal® can provide fast osteoarthritis knee pain relief that’s felt as early as 1 week following the injection and that can last up to 6 months.

Recommended number of sessions and maintenance: 

Cingal® (Hyaluronic Acid + Cortisone):
1 injection every 12-18 months, as needed

The number of sessions required depends on your goal, the severity of osteoarthritis and the individual patient.

How much does this treatment cost?

The consultation fee is $550.

It’s important to note that before any treatment is given, Dr. Fisher conducts a thorough assessment of the patient’s condition to determine the most appropriate course of action. The cost for this assessment is $550. If you are interested in any of the treatments offered by Dr. Fisher, it is recommended to schedule a consultation and assessment to discuss your options and determine the best approach for your individual needs.

Cingal® (Hyaluronic Acid + Cortisone):

$900 per treatment

Certain health plans and insurance providers may cover the expenses associated with the treatment. To determine if you have coverage, it’s recommended that you consult with your insurer.