How does viscosupplementation work for knee osteoarthritis. What are the different types of hyaluronan injections available. Who are ideal candidates for this treatment. What side effects can be expected from knee osteoarthritis injections. How is the procedure performed and what results can patients anticipate.

Understanding Hyaluronan Injections for Knee Osteoarthritis

Knee osteoarthritis is a debilitating condition that affects millions of people worldwide. As the cartilage in the knee joint wears away, it can lead to pain, stiffness, and reduced mobility. While there is no cure for osteoarthritis, various treatment options are available to manage symptoms and improve quality of life. One such treatment gaining popularity is hyaluronan injections, also known as viscosupplementation.

Hyaluronan injections involve introducing a gel-like substance directly into the knee joint to supplement the naturally occurring hyaluronic acid. This treatment aims to improve joint lubrication, reduce pain, and enhance overall knee function. But how exactly does it work, and who can benefit from this innovative approach?

The Science Behind Hyaluronan Injections

Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. It plays a crucial role in joint health by acting as both a lubricant and shock absorber. In individuals with osteoarthritis, the concentration of hyaluronic acid in the joints is often lower than normal, leading to increased friction and discomfort.

By injecting additional hyaluronic acid into the affected knee joint, viscosupplementation aims to restore the optimal balance of this vital substance. This can potentially lead to several benefits:

• Improved joint lubrication
• Enhanced shock absorption
• Reduced inflammation
• Increased mobility
• Decreased pain

Is viscosupplementation effective for all patients with knee osteoarthritis? While some individuals report significant pain relief and improved function after receiving hyaluronan injections, research results have been mixed. The effectiveness of the treatment can vary from person to person, and it may not provide substantial benefits for everyone.

Types of Hyaluronan Injections Available

Several hyaluronan injection products have been approved for use in treating knee osteoarthritis. Each product has its unique formulation and administration protocol. Some of the most commonly used options include:

1. 1% Sodium hyaluronate (Euflexxa)
2. High-molecular-weight hyaluronan (Orthovisc)
3. Hylan G-F20 (Synvisc)
4. Sodium hyaluronate (Hyalgan, Supartz)

These products differ in their molecular weight, concentration, and source of hyaluronic acid. Some are derived from rooster combs, while others are produced through bacterial fermentation. The choice of product often depends on factors such as the patient’s medical history, allergies, and the physician’s preference.

Administration Protocols

How are hyaluronan injections administered? The treatment protocol can vary depending on the specific product used:

• Single injection: Some formulations require only one injection.
• Multiple injections: Other products may involve a series of three to five weekly injections.

Regardless of the protocol, the procedure is typically performed in a doctor’s office and takes only a few minutes to complete.

Ideal Candidates for Knee Osteoarthritis Injections

While hyaluronan injections can be beneficial for many individuals with knee osteoarthritis, they are not suitable for everyone. Ideal candidates for this treatment are typically patients who:

• Have mild to moderate knee osteoarthritis
• Have not found sufficient relief from other conservative treatments
• Do not have any active joint infections or skin diseases at the injection site
• Are not allergic to eggs or poultry (for certain products)

Are there any specific conditions that might preclude someone from receiving hyaluronan injections? Patients with severe knee osteoarthritis, those with a history of severe allergic reactions, or individuals with bleeding disorders may not be suitable candidates for this treatment. It’s essential to consult with a healthcare provider to determine if viscosupplementation is appropriate for your specific situation.

Potential Side Effects and Risks

As with any medical procedure, hyaluronan injections can have potential side effects. While most patients tolerate the treatment well, it’s important to be aware of possible risks:

• Pain at the injection site
• Temporary swelling or warmth in the knee
• Mild bruising
• Redness or itching

In rare cases, more severe reactions can occur, such as:

• Pseudo-septic reaction (severe inflammation mimicking an infection)
• Allergic reactions (particularly in those with egg or poultry allergies)
• Joint infection (extremely rare)

How can patients minimize the risk of side effects? Following post-injection care instructions, such as avoiding strenuous activities for 48 hours after the procedure, can help reduce the likelihood of complications. It’s also crucial to inform your healthcare provider of any allergies or medical conditions before undergoing treatment.

The Procedure: What to Expect

Understanding the viscosupplementation procedure can help alleviate any anxiety patients may have about the treatment. Here’s what typically occurs during a hyaluronan injection session:

1. The knee area is cleaned and disinfected.
2. If there is excess fluid in the joint, it may be aspirated using a needle.
3. The hyaluronic acid is injected into the knee joint space using a fine needle.
4. A small bandage is applied to the injection site.
5. The patient is advised on post-procedure care.

The entire process usually takes less than 30 minutes, and most patients can return to their normal activities immediately after. However, it’s recommended to avoid strenuous exercise or heavy lifting for a couple of days following the injection.

Post-Procedure Care

To maximize the benefits of hyaluronan injections and minimize potential side effects, patients should follow these post-procedure guidelines:

• Apply ice to the knee if there is any swelling or discomfort
• Avoid high-impact activities for 48 hours
• Keep the injection site clean and dry
• Report any unusual symptoms to your healthcare provider

Efficacy and Duration of Results

One of the most common questions patients have about hyaluronan injections is how long the effects will last. The duration of pain relief can vary significantly from person to person, but typically:

• Pain relief may begin 4 to 12 weeks after the injection series
• Benefits can last for several months, with some patients reporting relief for up to a year
• The treatment can be repeated as necessary, usually not more than once every six months

What factors influence the effectiveness of hyaluronan injections? The severity of osteoarthritis, the patient’s overall health, adherence to post-procedure care, and engagement in complementary treatments (such as physical therapy) can all impact the outcome of viscosupplementation.

Combining Treatments for Optimal Results

While hyaluronan injections can be effective on their own, many healthcare providers recommend combining them with other osteoarthritis treatments for comprehensive care. This may include:

• Physical therapy to strengthen the muscles around the knee
• Weight management to reduce stress on the joint
• Low-impact exercises like swimming or cycling
• Use of assistive devices when necessary

By adopting a multi-faceted approach to knee osteoarthritis management, patients may experience more significant and longer-lasting relief from their symptoms.

Comparing Hyaluronan Injections to Other Treatments

Viscosupplementation is just one of several treatment options available for knee osteoarthritis. How does it compare to other common interventions?

Corticosteroid Injections

Corticosteroid injections are another type of injectable treatment for knee osteoarthritis. While they can provide rapid pain relief, their effects are typically shorter-lived compared to hyaluronan injections. Corticosteroids work by reducing inflammation, while hyaluronic acid aims to improve joint lubrication and shock absorption.

Oral Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) and pain relievers like acetaminophen are often used to manage osteoarthritis symptoms. While these medications can be effective for pain control, they don’t address the underlying issue of reduced hyaluronic acid in the joint. Hyaluronan injections may offer a more targeted approach for some patients.

Physical Therapy

Physical therapy plays a crucial role in managing knee osteoarthritis by strengthening the muscles around the joint and improving flexibility. While it doesn’t directly address joint lubrication like hyaluronan injections, it can be an excellent complementary treatment to enhance overall knee function and stability.

Is one treatment superior to the others? The most effective approach often involves a combination of therapies tailored to the individual patient’s needs and response to treatment. Consulting with a healthcare provider can help determine the most appropriate treatment plan.

Future Developments in Viscosupplementation

As research in the field of osteoarthritis treatment continues to evolve, new developments in viscosupplementation are emerging. Some areas of ongoing investigation include:

• Combination therapies: Exploring the potential benefits of combining hyaluronic acid with other substances like platelet-rich plasma (PRP) or stem cells
• Novel formulations: Developing hyaluronic acid products with improved molecular structures for enhanced efficacy and duration of action
• Targeted delivery systems: Investigating methods to ensure more precise and effective delivery of hyaluronic acid to the affected joint areas
• Personalized treatment protocols: Tailoring viscosupplementation regimens based on individual patient characteristics and biomarkers

What potential advancements might we see in the coming years? While it’s difficult to predict with certainty, ongoing research may lead to more effective and longer-lasting hyaluronan injections, as well as expanded applications for other types of joint osteoarthritis beyond the knee.

The Role of Regenerative Medicine

The field of regenerative medicine offers exciting possibilities for the future of osteoarthritis treatment. Some areas of exploration include:

• Stem cell therapy: Using stem cells to potentially regenerate damaged cartilage tissue
• Growth factors: Incorporating growth factors into hyaluronic acid formulations to promote tissue repair
• Gene therapy: Exploring ways to modify gene expression to enhance the body’s natural healing processes

These emerging technologies may eventually complement or enhance the effectiveness of traditional viscosupplementation treatments, offering new hope for patients with knee osteoarthritis.

In conclusion, hyaluronan injections represent a valuable treatment option for many individuals suffering from knee osteoarthritis. While not a cure, this approach can provide significant pain relief and improved joint function for some patients. As with any medical treatment, it’s essential to discuss the potential benefits and risks with a healthcare provider to determine if viscosupplementation is the right choice for your specific situation. With ongoing research and development, the future of knee osteoarthritis treatment looks promising, potentially offering even more effective and personalized options for patients in the years to come.

Treating Knee Osteoarthritis With Hyaluronan Injections

Written by WebMD Editorial Contributors

• How Do These Knee Osteoarthritis Injections Work?
• What Joints Can Be Treated With These Osteoarthritis Injections?
• Candidates for Knee Osteoarthritis Injections
• Side Effects of Knee Osteoarthritis Injections
• What to Expect From Knee Osteoarthritis Injections

There are several versions of hyaluronan injections — also called viscosupplementation — that are used to treat knee osteoarthritis. They are injected directly into the joint. They include:

• 1% Sodium hyaluronate (Euflexxa,)
• High-molecular-weight hyaluronan (Orthovisc)
• Hylan G-F20 (Synvisc)
• Sodium hyaluronate (Hyalgan , Supartz)

They can help reduce the pain in a knee affected by osteoarthritis, increasing mobility and allowing more activity.

Normal joint fluid contains a substance called hyaluronan. It acts like a shock absorber and lubricant in your joint and is needed to help the joint work properly. Hyaluronan is highly viscous, allowing the cartilage surfaces of the bones to glide upon each other smoothly. This leads to decreased symptoms of osteoarthritis.

Currently, these drugs are only approved for treatment of mild to moderate knee arthritis.

These drugs are used to treat knee osteoarthritis pain in people who have not found significant relief of their symptoms from:

• Physical therapy
• Exercise
• Heat or cold
• Over-the-counter pain relievers

These drugs can be injected into both knees or just a single knee joint.

Potential side effects of these knee osteoarthritis injections include joint swelling and pain. They can’t be used by people with skin or joint infections. In addition, most varieties are made from processed chicken or rooster combs and should not be used in people with egg or poultry allergies. Euflexxa, however, is safe to use in people with egg allergies.

Occasionally, a severe reaction with swelling, redness, and pain, called a pseudo septic reaction, can occur with some forms of these viscosupplementation materials.

Treatment with knee osteoarthritis injections ranges from a one-time injection to weekly injections for three to five weeks. Pain relief is usually obtained by four to 12 weeks, and the effect has been shown to last for up to several months. The treatment can be repeated as necessary.

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Viscosupplementation Treatment for Knee Arthritis – OrthoInfo

Osteoarthritis of the knee is one of the leading causes of disability in the United States. It develops slowly and the pain it causes worsens over time. Although there is no cure for osteoarthritis, there are many treatment options available to help people manage pain and stay active.

In its early stages, arthritis of the knee is treated with nonsurgical methods. Your doctor may recommend a range of treatments, including:

• Modifying your activities
• Weight loss
• Pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
• Physical therapy
• Corticosteroid injections

Another treatment option is a procedure called viscosupplementation. If you have tried all other nonsurgical treatment methods and your pain continues to limit your activities, viscosupplementation may be an option.

In this procedure, a gel-like fluid called hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads. People with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints. The theory is that adding hyaluronic acid to the arthritic joint will facilitate movement and reduce pain.

The most recent research, however, has not found viscosupplementation to be effective at significantly reducing pain or improving function. Although some patients report pain relief with the procedure, some people are not helped by the injections.

Viscosupplementation was first used in Europe and Asia, and was approved by the U.S. Food and Drug Administration in 1997. Several preparations of hyaluronic acid are now commercially available.

Depending on the product used, you will receive one to five shots over several weeks.

During the procedure, if there is any swelling in your knee, your doctor may remove (aspirate) the excess fluids before injecting the hyaluronic acid. Usually, the aspiration and the injection are done using only one needle injected into the joint, Some doctors may prefer to use two separate syringes.

For the first 48 hours after the shot, you should avoid excessive activity, such as jogging or heavy lifting.

Side Effects

You may notice a local reaction, such as pain, warmth, and slight swelling immediately after the shot. These symptoms generally do not last long. You may want to apply an ice pack to help ease them.

Complications

Rarely, patients may develop a local allergy-like reaction in the knee. In these cases, the knee may become full of fluid, red, warm, and painful. If this occurs, contact your doctor immediately.

Infection and bleeding are also very rare complications of this procedure.

As is noted above, some patients will not be helped by viscosupplementation. For those who report pain relief with the procedure, it may take several weeks to notice an improvement. How long the effects last varies. Some patients report pain relieving effects for several months following the injections.

If the injections are effective they may be repeated after a period of time, usually 6 months.

Although some patients report relief of arthritis symptoms with viscosupplementation, the procedure has never been shown to reverse the arthritic process or re-grow cartilage.

The effectiveness of viscosupplementation in treating arthritis is not clear. It has been proposed that viscosupplementation is most effective if the arthritis is in its early stages (mild to moderate), but more research is needed to support this. Research in viscosupplementation and its long-term effects continues.

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Osteoarthritis of the knee: | symptoms | preparations

Osteoarthritis is one of the most common joint diseases, accompanied by the destruction of hyaline cartilage. Over time, bones, ligaments and muscles are involved in the pathological process.
Arthrosis of large joints have their own names: hip – coxarthrosis, knee – gonarthrosis.
In the absence of timely medical care, the pathology steadily progresses and becomes the cause of severe pain, a decrease in motor ability. In the absence of adequate treatment, the progression of arthrosis may lead to the need for joint replacement.

Symptoms

One of the first signs of arthrosis is pain in the knee when walking and moving. In the early stages, patients experience discomfort and temporary stiffness after rest. At first, the pain appears periodically and does not have a clear localization, but increases with physical exertion.

In the future, the symptoms become brighter, the range of motion decreases markedly.

Pain syndrome in gonarthrosis is characterized by:

• starting pains in the morning or after a long rest;
• association with physical activity – the knee hurts more when walking, standing or running for a long time. At rest, the pain subsides;
• connection with weather conditions – the pain increases with increasing humidity and atmospheric pressure, cooling;
• blockade of the joint, which is accompanied by sharp pain. Jamming occurs due to the infringement of a fragment of cartilage or bone that has separated from the cartilaginous covering or epiphysis of the bone.

Arthrosis proceeds in waves, exacerbations alternate with periods of remission. Exacerbations cause inflammation of the synovial membrane of the joint, so the nature of the pain changes to constant, aching and bursting. She worries both during movement and at rest.

Reasons

Arthrosis does not always have an obvious cause, and then one speaks of idiopathic, primary gonarthrosis. The cause of secondary arthrosis can be:

• injury – fractures, dislocations, damage to the meniscus and ligaments of the knee;
• birth defect;
• connective tissue weakness, joint hypermobility;
• autoimmune disease – rheumatoid arthritis, lupus erythematosus;
• infectious and inflammatory process – purulent arthritis, tuberculosis;
• high loads: running and intense squats are especially dangerous for the knees;
• overweight.

Arthrosis of the knee joint: treatment, preparations, injections

Conservative therapy is effective at stages 1-2 of the disease; in the later stages, surgery is unlikely to be avoided.
Acute symptoms are relieved with non-steroidal anti-inflammatory drugs – Diclofenac, Ibuprofen and their analogues tablets. If NSAIDs do not help, then corticosteroid drugs are prescribed.
Chondroprotectors are used to slow down the degradation of cartilage.
To improve blood supply and nutrition of articular structures, microcirculation improvement agents are used – Normoven, Nicotinic Acid, Cinnarizine, Pentoxifylline.
However, the best treatment for arthrosis today is injection therapy.

Intramuscularly prescribed:

• non-steroids – Flamax, Ketonal, Amelotex, Movalis, Lornoxicam, Diclofenac, Naklofen;
• hormones – Celeston, Flosteron, Diprospan, Hydrocortisone;
• vitamins – Neurorubin, Kombilipen, Milgamma, Trigamma, Compligam.

Hyaluronic acid preparations are prescribed intra-articularly, the frequency of injections and dosage is selected by the doctor based on the diagnosis. Glucocorticosteroids can be injected into the joint, but they should be prescribed with caution, since with frequent use they can worsen the condition of the cartilage tissue and aggravate the course of arthrosis.

Intra-articular injections

One of the latest developments of Czech scientists is carboxytherapy. It is based on the introduction of carbon dioxide into the joint cavity, which provokes interstitial hypoxia. The gas is supplied through a special device, causing acute oxygen starvation in the articular structures.

The result is a sharp influx of blood to the diseased area and a rapid acceleration of metabolism. Within a few minutes, the gas is removed, and the running mechanism works for a long time.
Another modern method involves the introduction of plasma into the joint – a liquid with blood cells. In this case, plasma with platelets is used, which perfectly relieves inflammation and pain, significantly slowing down the destructive process.

Physiotherapy

Comprehensive treatment of arthrosis of the knee joint includes physiotherapy. They improve local blood circulation, increase range of motion and potentiate the effect of drugs.

The doctor may prescribe:

• SWT – ultrasound – low-frequency currents contribute to the removal of osteophytes;
• magnet – the magnetic field stimulates metabolic processes, thereby accelerating tissue regeneration;
• laser – under the influence of radiation, intracellular metabolic processes are significantly improved, chemical reactions are accelerated, since the laser “works” as a conductor and enhances the effect of other methods of treatment;
• myostimulation – impulse currents restore the natural function of periarticular structures;
• electro-, phonophoresis – the introduction of painkillers or chondroprotective drugs by means of electric current or ultrasound;
• ozone therapy – oxygenation of “weak” places to activate their regeneration.

An important role in the treatment of arthrosis is played by therapeutic exercises, according to indications, massage procedures can be performed.

Operation

Surgical intervention is resorted to in advanced cases, at the 3rd stage of gonarthrosis. Most often, endoprosthesis is performed – today it is the most reliable technique.

After the operation, the body recovers in 3-6 months. Side effects and complications are rare.

There are also organ-preserving operations:

• laser and rehabilitation arthroscopy;
• plasma ablation;
• chondroplasty.

If you are prescribed intra-articular injections, or you need to repeat the course, please contact us. The center provides the service of administering drugs into the joint cavity, manipulations are carried out by experienced doctors of the highest category, so patients feel as comfortable as possible during and after the procedures.

Make an appointment by phone +375 29 628 85 82

Treatment of arthrosis with chondroprotectors | Dikul Center

Treatment of arthrosis with chondroprotectors | Center Dikul

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2023-06-23

Treatment of arthrosis with chondroprotectors

Chondroprotectors are special drugs for arthrosis that improve the metabolism in the affected joint, which means they prevent or slow down its destruction. Most drugs for arthrosis of this kind contain biologically active substances of cartilage. Below we give the main, most important chondroprotectors.

1. Rumalon. This arthrosis medicine consists mainly of bone marrow and cartilage extract from young animals. The medicine includes the following biologically active substances: peptides, proteoglycans, amino acids, nucleotides, chondrocytes, bone marrow cells.
   The medicine for arthrosis improves the production of GAGs in the diseased joint, the synthesis of hyaluronic acid also improves, the composition of the synovial fluid becomes more favorable for the treatment of arthrosis, and the lubrication of the diseased joint also improves. This drug must be administered intramuscularly every other day, the dose of the drug for arthrosis is 0 1 ml. The cure for arthrosis occurs after 25 injections of rumanol. Side effects on this medicine for arthrosis are rare, but swelling of the face, a rash on the skin, and eosinophilia still occur. Treatment of arthrosis with this drug can be carried out only if arthrosis is in the first or second stage – in the third, the drug cannot be used.
2. Artron (chondroitin sulfate). The principle of its action on the diseased joint is very similar to Rumanol, as well as other properties, including the dosage and time of the full course of treatment.
3. Arteparon. This arthrosis drug is a combination of proteoglycans and GAGs. Since its composition is close to the composition of the cartilage of the diseased joint, there are no particular difficulties on the way of the drug from arthrosis to cartilage. It reduces the activity of proteases in the cartilage and inhibits the destructive activity of arthrosis. Application – intramuscular, it is necessary to enter 2 times a week for 2 months (dosage – 1 milliliter), then – once every two weeks for a period of 4 months.
4. Mukartin. This medicine for arthrosis is a mucopolysaccharide sulfate ester, the principle of action on the diseased joint is similar to arteparone, the scheme of application is also the same, but the dosage is different – 2 ml.

Introduction of inhibitors of proteolytic enzymes in arthrosis.

This method is used for severe pain and reactive synovitis. Most often, inhibitors are administered for arthrosis of the knee joint. The most popular drugs for this type of arthrosis are Trasilol (Countercal) and Gordox. These drugs inhibit trypsin, chymotrypsin, cathepsins and other proteases. Trasilol or Gordox is injected into the joint, the dosage is 25,000 units. The treatment time for arthrosis is from 2 to 5 injections of these drugs for arthrosis, the intervals between injections are 2-3 days. Before the introduction of the drug into the body, it is necessary to make an intramuscular injection of diphenhydramine, and the medicine for arthrosis itself must be mixed with 0.002 g of hydrocorticone – this will eliminate acute pain from arthrosis.

Application of artificial lubrication of the joints.

This method of treating arthrosis improves the correspondence of two joints to each other and reduces the deformation and destruction of the cartilage. As an artificial lubricant, polyvinylpyrrolidone (PVP) or its 6% solution (hemodez) usually act.

These arthrosis drugs are injected into large joints only. Injections should be made once a week, dosage – 5 ml of a 15% solution of PVP mixed with 25 ml of hydrocortisone – to eliminate pain from arthrosis. The course usually consists of 4-6 injections, although this number can be changed at the discretion of the doctor. If the joint with arthrosis is small, then the amount of PVP administered is reduced from one and a half to two times. This type of treatment for arthrosis is effective at any stage of reactive synovitis.

The following types of artificial joint lubricants are available:

• 15% PVP solution (water)
• The same solution, but in combination with hyaluronic acid. This mixture is used in the first and second stages of arthrosis without the presence of synovitis.
• The same solution in combination with arteparone. It is used in cases where the cartilage of the joint affected by arthrosis is largely destroyed, the menisci are affected, as well as in the case of arthrosis that appeared after any injury.