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Viscosupplementation for the Knee Print E-mail

Introduction

The human knee will bend an average of 1 million times in one year. To aid in all that movement, the knee is filled with a substance called synovial fluid. Synovial fluid acts as a lubricant and shock absorber to cushion the knee joint.

Viscosupplementation is becoming a popular treatment to relieve pain caused by osteoarthritis of the knee. The process involves a series of injections into the knee joint designed to reduce pain caused by arthritic changes in the joint's surfaces and fluid.

Sometimes, either through the effects of aging, accident or a disease, such as arthritis, components of the synovial fluid may begin to break down. One such component is hyaluronic acid or HA. In patients with osteoarthritis, the concentration of HA in the synovial fluid is reduced resulting in smaller and less effective molecules. The HA loses some of the lubricating and shock absorbing properties that protect the knee. Researchers believe this can result in joint pain, stiffness and perhaps an onset or worsening of osteoarthritis.

Sometimes, either through the effects of aging, accident or a disease, such as arthritis, components of the synovial fluid may begin to break down. One such component is hyaluronic acid or HA. In patients with osteoarthritis, the concentration of HA in the synovial fluid is reduced resulting in smaller and less effective molecules. The HA loses some of the lubricating and shock absorbing properties that protect the knee. Researchers believe this can result in joint pain, stiffness and perhaps an onset or worsening of osteoarthritis.

How Does Viscosupplementation Work?

Viscosupplementation is a type of therapy in which the hyaluronic acid in the knee can be augmented through a series of injections. Viscosupplementation will not cure arthritis or repair damaged cartilage in your knee, but it may relieve joint pain for a period of time.

Researchers are not exactly sure how HA injections relieve pain. Theories suggest that the injection of supplemental HA may induce the body to produce its own HA in the knee. Researchers also believe HA may have anti-inflammatory properties, or that the new "lubricant" in the knee protects and soothes the nerve endings exposed by the degraded cartilage of the arthritic knee.

Hyaluronic acid is a naturally occurring substance that is present in not only synovial fluid, but also in the eyeballs, skin and cartilage. When isolated, it is a thick viscous fluid having a consistency similar to an egg white. Viscosupplements use purified HA that is derived from either rooster combs or genetically engineered cells to augment the natural HA in the knee joint.

How is It Administered?

The enzymes of the stomach break down HA, so there is no pill form of viscosupplementation. Therapy is available only through injection into the knee. The injection is directly into the knee joint from a point on the side and under the kneecap. The injections usually take no longer than 15 seconds. Three viscosupplements are approved for use in the United States: Hyalgan®, Synvisc® and SupartzTM . Depending on which product your physician prescribes, the administration is either through three or five injections, one each week. According to the manufacturers, it can take up to 12 weeks for the injections to take full effect.

Who Can Benefit?

Viscosupplementation is recommended for people with osteoarthritis who are not responding to traditional therapies, such as pain-relief medications or exercise. It also is an option for people who have arthritis and are not candidates for a knee replacement. People in this category would include those whose knee is not completely impaired or those who may be considered too young for a knee replacement.

What Are the Side Effects?

You should not receive HA viscosupplementation if you ever had an allergic reaction to any other hyaluronate preparations or are allergic to poultry products. You should not receive the injections if you have an infection or skin disease around the injection area. As with any injection, mild pain may occur at the injection site. You may also have swelling, heat and/or redness, rash, itching, or bruising around the joint. These reactions are generally mild and usually do not last long.

How Effective is It?

A number of clinical studies have been conducted regarding HA viscosupplementation.

A multi-centered study from Canada published in the journal of the Osteoarthritis Research Society, Osteoarthritis and Cartilage, December 1995, concluded that HA viscosupplementation is a safe and effective treatment. One group of patients was treated with hyaluronic acid. The other received non-steroidal anti-inflamatory drugs (NSAIDs). The researchers found that after six months, the group receiving HA had better pain relief than those receiving NSAIDs.

Conclusion

There are a wide range of options to treat osteoarthritis of the knee. Although researchers aren't sure why viscosupplements can reduce pain, more and more doctors are using these injections to help treat their patients' knee pain.

 

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