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Rx injection: What is a rooster comb injection?
Health Education

What is a rooster comb injection?

The comb of a rooster consists of hyaluronic acid, which serves as a lubricant in joints
Chad Shaffer, MD, medical writer and reviewer for SingleCare
By | Dec. 6, 2023

Rooster comb injections may sound medieval, but they are a fascinating, research-proven treatment for knee arthritis. Stiff, achy knees are a bane to so many of us, that it was welcome news when a new treatment option was approved 30 years ago, promising to reduce arthritis pain by injecting a lubricating fluid into the joints. The premise is termed viscosupplementation, based on adding more viscous fluid to the joint space, and since initially released, product options have certainly expanded. What this all has to do with roosters and what exact benefits and risks the infections involve are some of the topics we will fill you in on.

What is a rooster comb injection? 

The floppy, red comb of a rooster adorns the bird’s head and is made of hyaluronic acid. That same substance is found in our joints, functioning as a lubricant and shock absorber. Extracting hyaluronate from the rooster’s comb or synthesizing it in a lab provides the active ingredient for viscosupplements. The term “rooster comb injection” is now applied to this class of therapeutics, even if a product does not get its substrate from a chicken. Products in the class include:

By injecting a viscosupplement into the synovial fluid of a joint with osteoarthritis, the hope is that the worn-down cartilage of the joint glides more smoothly and less painfully. The simple injection procedure is done in a medical office by a primary care, orthopedic, or sports medicine provider. Using sterile methods, a needle is inserted into the joint space in order to inject the viscosupplement. It takes just a minute, and you can return home afterward.

Who can benefit from rooster comb injections?

Hyaluronic acid injections, or rooster comb injections as they are often called, are only approved by the Food and Drug Administration (FDA) for use in osteoarthritis of the knee joint. Other forms of arthritis, such as rheumatoid and psoriatic arthritis, and other joints are not included in the indication. That may sound like a limiting factor for its use, but when you consider that osteoarthritis is the most common type of arthritis and the knee joint is most often affected, it becomes clear that rooster comb injections can potentially benefit a vast number of people.

How long do rooster comb injections last?

Improvements in joint pain and stiffness may last six months. However, we should back up a bit to get our expectations in check. Not everyone improves after rooster comb shots. In fact, clinical studies and expert guidelines are split on whether this modality is sufficiently effective and advisable. You will want to get the medical advice of your primary care provider or orthopedic surgeon for help in determining if rooster comb injections are right for you.

What are the side effects of rooster injections?

Putting these shots into a joint is meant to provide pain relief, but the potential side effects include pain, swelling, and redness at the site. These types of local immune reactions can occur with other types of joint injections, so it is a phenomenon that is not unique to rooster comb injections. Systemic immune reactions can create general achiness, but they can also amount to full-blown hypersensitivity with allergic reactions. To lessen this risk, anyone with a history of bird protein, feathers, or eggs may need to avoid viscosupplements.

How much do rooster comb injections cost?

As you might imagine, the price of rooster comb shots varies depending on the product. Some products are given as a weekly injection for three to five weeks, while others are only given once. For example, Supartz FX is injected every week for five weeks, but Durolane is given one time. The total cost of a treatment course usually ends up being fairly similar, ranging between about $1200 and $1800. Courses of injections are sometimes repeated after six months or more. A SingleCare discount card can help keep the costs from piling up too much.

Frequently asked questions about rooster comb injections

What are rooster comb injections made from?

Hyaluronic acid is the key ingredient in viscosupplement shots for knee arthritis. The substance allows joint surfaces to glide more smoothly, cushion impacts, and reduce inflammation. The hyaluronate was historically extracted and purified from the combs of roosters, but it can also be synthesized in laboratories.

Is rooster comb better than cortisone?

Results of clinical trials are conflicted on whether viscosupplementation is better than cortisone injections, which are used for their anti-inflammatory properties in the setting of different types of arthritis and in various joints. Regarding knee osteoarthritis, some studies have found rooster comb shots to be superior, and others have found them to be no better than corticosteroid shots. Other findings pointed out that viscosupplements may have longer-lasting benefits but not act as quickly as steroid injections.

Is Synvisc the same as rooster comb?

Synvisc is one of the brand-name hyaluronic acid products indicated by the FDA for knee osteoarthritis. Given as a three-dose series of injections, it is considered one of the “rooster comb shots” based on its active ingredient, hyaluronate. The manufacturer also has a single-dose version called Synvisc-One.

Does Medicare cover rooster comb injections for the knee?

In general, Medicare considers viscosupplement shots as medically reasonable and necessary for knee osteoarthritis when other conservation measures have been tried, such as physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections. According to Sanofi, the maker of Synvisc products, all local Medicare Administrative Contractors cover their products in these circumstances.

Can rooster comb injections be used in conjunction with other treatments or medications?

Rooster comb injections do not need to stand alone as a treatment for osteoarthritis of the knee. They can be used in conjunction with corticosteroid shots, NSAIDs, platelet-rich plasma (PRP) injections, and physical therapy, but not all of these may be right for you. If these are ineffective, knee replacement is yet another option. Check with your team of healthcare professionals to find the optimal regimen for your knee pain.

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