Viscosupplementation is a treatment option for osteoarthritis that involves injecting a gel-like substance called hyaluronic acid (also called hyaluronan or HA) into the knee joint. Hyaluronic acid is naturally produced in small amounts by the body and acts as a lubricant and shock absorber in the joints. In osteoarthritis, the amount of hyaluronic acid in the joint decreases. Viscosupplementation aims to replenish this lubricant in the joint space.
How Does Canada Viscosupplementation Work?
Hyaluronic acid is a glycosaminoglycan found throughout connective, epithelial, and neural tissues. Injoints, it is present in high concentration and serves as a lubricant and elastic dampener, absorbing physical stresses. In the osteoarthritic joint, thelevel and molecular weight of endogenous hyaluronic acid decreases. This reduction inviscoelasticity of the synovial fluid may be an underlying factor in osteoarthritic pain. Viscosupplementation attempts torestore rheologic and mechanical properties to the osteoarthritic joint by supplementationwith exogenous high molecular weight hyaluronic acid.
The Mechanism Of Action
The precise mechanism by which viscosupplementation exerts its therapeutic effects is still not fully understood. However, the following actions have been proposed:
– Lubrication and Shock Absorption: Exogenous high molecular weight hyaluronic acid replenisheslubricating and elastic properties to the synovial fluid, absorbing physical stresses on the joint.
– Reduction of Inflammatory Mediators: Hyaluronic acid may suppress proteolytic enzymes andinflammatory cytokines implicated in cartilage degradation in osteoarthritis
– Chondroprotection: It stimulates the production of proteoglycans and hyaluronic acid bychondrocytes, helping maintain cartilage matrix integrity
– Analgesic Effect: The mechanism is unclear but it may mediate pain relief through suppression ofinflammatory and/or nociceptive pathways.
Who Is A Candidate For Viscosupplementation?
Viscosupplementation is usually considered for patients with mild to moderate osteoarthritis of the knee who have not responded sufficiently to conventional treatments such as medications, weight loss and exercise. Specifically:
– Patients with X-ray confirmed osteoarthritis of the knee
– Persistent knee pain rated as at least 4 on a 10 point pain scale
– Failure of response to core treatments like acetaminophen, NSAIDs, exercises
– No recent joint infection or underlying inflammatory arthritis
– No prior knee surgery other than minor arthroscopic surgery
– Body Mass Index (BMI) less than 38 kg/m2
The Treatment Process
A series of injections of hyaluronic acid product is administered, usually 5 injections given once a week for 5 consecutive weeks. Common brands used in Canada include Synvisc-One, Supartz, Hyalgan and Euflexxa. Steroid injections should be avoided for 4 weeks before and after viscosupplementation. Patients are advised to avoid high impact activities for 48 hours post injection. Mild analgesic cream or pain medication can be used as needed after the procedure.
Effectiveness Of Viscosupplementation
High quality clinical studies and meta-analyses have shown viscosupplementation to be an effective treatment for knee osteoarthritis. A few key points about its effectiveness:
– It provides pain relief and functional improvement for 6-13 months on average
– Studies have shown superiority over placebo, intraarticular steroid or oral NSAIDs
– Single injection products like Synvisc-One have been shown non-inferior to multi-injection products
– Better outcomes seen in patients with mild-moderate osteoarthritis versus severe osteoarthritis
– Multiple injection therapies seem to have superior outcomes than single injection
– Effect diminishes over time but overall many patients experience an increase in time before requiring further treatment like knee replacement surgery.
Safety Of Viscosupplementation
Overall, viscosupplementation has an excellent safety profile. Common mild side effects include:
– Pain, swelling, or tenderness at the injection site lasting 1-3 days (in less than 5% patients)
– Rare allergic reactions (less than 1%) like rash, itching, hives
– Very rare serious adverse effects like severe allergic reaction or infection
In general, it is considered safe for most osteoarthritic knee patients. However, people with a history of knee joint infection or underlying inflammatory arthritis may not be candidates. Precautions must also be taken in people with bleeding disorders or on blood thinners. Overall, viscosupplementation is quite safe when administered correctly by an experienced medical practitioner.
Viscosupplementation with hyaluronic acid injections offers patients with knee osteoarthritis a worthwhile non-surgical option to reduce pain and improve function through replenishing the lubricating fluid in the joint. When used according to clinical guidelines, it has demonstrated efficacy over 6-13 months with an excellent safety profile. For appropriate candidates, viscosupplementation should be considered as one of the core treatment modalities for managing osteoarthritic knees.
About Author – Ravina Pandya
Ravina Pandya,a content writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemicals and materials, etc. With an MBA in E-commerce, she has expertise in SEO-optimized content that resonates with industry professionals. LinkedIn Profile