People with osteoarthritis have a lower concentration of hyaluronic acid in their joints. This substance comes from the joint lining (synovium) and acts as a lubricant to enable the joint surfaces to move smoothly and better absorbs joint loads.
Viscosupplementation injects a preparation of hyaluronic acid into the joint to supplement the affected joint deficiency in this substance.
It is as if one is putting oil in a sticking or squeaking hinge to improve lubrication and thus function.
Studies have shown this to relieve pain in many patients who did not get relief from first line arthritis treatment of non-steroidal anti-inflammatories (oral and topical), physical therapy and even corticosteroid injections. The technique has been used in Europe and Asia for many years, but the US Food and Drug Administration did not approve this until 1997. It is approved only for the treatment of osteoarthritis of the knee.
Most preparations (e.g. Synvisc, Hyalgan) are made from rooster combs although one is manufactured from bacterial cultures for use in individuals allergic to poultry products.
The injection is best done in a non-swollen knee and three injections are performed, each a week apart. The treatment can be repeated every six months, although benefit can be longer lasting.
In Dr Glidden?s experience approximately 7 out of 10 patients note benefit. This treatment doesn?t work on everyone. An unstable knee joint which can occur from arthritis doesn?t respond as well. On the other hand, the worse degree of arthritis by x-ray does not correlate with the lesser chance of success.
This Viscosupplementation has been a recent significant addition to the non-operative treatment options for osteoarthritis of the knee. Even if one eventually would need some type of knee replacement. The injections could over the short term enable better knee function and thus help improve range of motion and strength. This ?prehabilitation? (rehab before knee surgery) greatly improves the post operative recovery of knee function.
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