How do hyaluronan injections work for knee osteoarthritis. What are the potential benefits and side effects of this treatment. Who are the ideal candidates for hyaluronan injections. How long does the pain relief from these injections last.

Understanding Hyaluronan Injections for Knee Osteoarthritis

Hyaluronan injections, also known as viscosupplementation, have emerged as a promising treatment option for individuals suffering from knee osteoarthritis. These injections aim to alleviate pain and improve joint mobility by supplementing the synovial fluid with a gel-like substance that mimics its natural properties.

Knee osteoarthritis is a degenerative joint condition that affects millions of people worldwide. As the disease progresses, the cartilage in the knee joint breaks down, leading to pain, stiffness, and reduced mobility. Hyaluronan injections offer a non-surgical approach to managing these symptoms and potentially slowing the progression of the disease.

Types of Hyaluronan Injections

Several varieties of hyaluronan injections are available for treating knee osteoarthritis:

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

Each of these products has unique characteristics and may be preferred by different healthcare providers based on their experience and patient-specific factors.

The Science Behind Hyaluronan Injections

Hyaluronan is a naturally occurring substance found in the synovial fluid surrounding joints. It plays a crucial role in joint health by acting as a lubricant and shock absorber. In individuals with osteoarthritis, the concentration of hyaluronan in the joint fluid is often lower than normal, which can contribute to pain and reduced joint function.

How do hyaluronan injections work to alleviate osteoarthritis symptoms? These injections aim to restore the viscoelastic properties of the synovial fluid by introducing a high concentration of hyaluronan directly into the affected joint. This supplementation is thought to improve joint lubrication, reduce inflammation, and potentially stimulate the production of natural hyaluronan by the body.

The Viscosupplementation Process

The procedure for administering hyaluronan injections is relatively straightforward:

1. The knee joint is cleaned and sterilized.
2. If excess fluid is present, it may be aspirated from the joint.
3. The hyaluronan solution is injected directly into the joint space.
4. Depending on the specific product, patients may receive one to five injections over several weeks.

It’s important to note that while the injection itself is quick, patients are often advised to avoid strenuous activities for 48 hours following the procedure to maximize its effectiveness.

Efficacy and Duration of Pain Relief

A common question among patients considering hyaluronan injections is: How long does the pain relief from these injections typically last? While individual responses can vary, many patients report significant pain relief within 4 to 12 weeks after completing the injection series. The effects of the treatment have been shown to last for several months in some cases.

Research on the long-term efficacy of hyaluronan injections has yielded mixed results. Some studies suggest that the benefits may extend beyond the initial relief period, potentially due to the treatment’s ability to stimulate the body’s natural production of hyaluronan. However, more research is needed to fully understand the long-term effects of this therapy.

Comparing Hyaluronan Injections to Other Treatments

How do hyaluronan injections compare to other osteoarthritis treatments in terms of effectiveness? While direct comparisons can be challenging due to variations in study designs and patient populations, some research suggests that hyaluronan injections may offer comparable or superior pain relief to oral medications or corticosteroid injections, especially in the long term.

However, it’s important to note that the most recent research has not consistently found viscosupplementation to be significantly more effective than placebo in reducing pain or improving function. This highlights the need for individualized treatment approaches and careful patient selection.

Ideal Candidates for Hyaluronan Injections

Determining who is most likely to benefit from hyaluronan injections is crucial for optimizing treatment outcomes. Generally, these injections are considered for patients with mild to moderate knee osteoarthritis who have not found sufficient relief from other conservative treatments.

What criteria do healthcare providers use to identify suitable candidates for hyaluronan injections? Factors that may influence the decision include:

• Severity of osteoarthritis (typically mild to moderate cases)
• Patient age and overall health
• Previous response to other treatments
• Absence of certain contraindications (e.g., joint infections, severe inflammation)

It’s worth noting that hyaluronan injections are currently approved only for knee osteoarthritis, although research is ongoing to explore their potential benefits for other joints affected by osteoarthritis.

Potential Side Effects and Precautions

As with any medical intervention, hyaluronan injections carry potential risks and side effects. What are the most common side effects associated with this treatment? Patients may experience:

• Temporary pain or swelling at the injection site
• Mild warmth or redness around the knee
• In rare cases, a more severe inflammatory reaction

It’s crucial for patients to be aware of these potential side effects and to report any unusual or severe reactions to their healthcare provider promptly.

Contraindications and Special Considerations

Certain factors may preclude some individuals from receiving hyaluronan injections. These include:

• Active skin infections or joint infections in the treatment area
• Known allergies to hyaluronan products or their components
• For most hyaluronan products, allergies to eggs or poultry (as they are often derived from rooster combs)

It’s worth noting that one product, Euflexxa, is safe for use in individuals with egg allergies, as it is not derived from avian sources.

Integrating Hyaluronan Injections into a Comprehensive Treatment Plan

While hyaluronan injections can provide significant relief for some patients, they are most effective when incorporated into a comprehensive osteoarthritis management plan. How can patients maximize the benefits of this treatment? A multifaceted approach often includes:

• Physical therapy to improve joint strength and flexibility
• Weight management to reduce stress on the affected joint
• Low-impact exercises to maintain joint health
• Use of assistive devices when necessary
• Appropriate pain management strategies

By combining hyaluronan injections with these other interventions, patients may achieve better overall outcomes and improved quality of life.

Future Directions in Hyaluronan Therapy

As research in the field of osteoarthritis treatment continues to evolve, new developments in hyaluronan therapy are emerging. What advancements can we expect in the coming years? Some areas of ongoing investigation include:

• Development of longer-lasting hyaluronan formulations
• Exploration of combination therapies (e.g., hyaluronan with growth factors or stem cells)
• Investigation of hyaluronan’s potential in treating osteoarthritis in other joints
• Refinement of patient selection criteria to improve treatment outcomes

These ongoing research efforts hold promise for enhancing the efficacy of hyaluronan injections and expanding their applications in the treatment of osteoarthritis.

Making an Informed Decision About Hyaluronan Injections

For individuals considering hyaluronan injections as a treatment option for knee osteoarthritis, it’s essential to engage in thorough discussions with healthcare providers. What questions should patients ask when considering this treatment? Some key points to address include:

• The potential benefits and risks specific to their case
• The expected duration of relief and the possibility of repeated treatments
• How hyaluronan injections fit into their overall osteoarthritis management plan
• The cost of treatment and insurance coverage considerations
• Alternative treatment options that may be suitable for their condition

By gathering comprehensive information and carefully weighing the pros and cons, patients can make informed decisions about whether hyaluronan injections are the right choice for managing their knee osteoarthritis.

In conclusion, hyaluronan injections represent a valuable tool in the arsenal of treatments available for knee osteoarthritis. While they may not be suitable for everyone, these injections offer a non-surgical option for pain relief and improved joint function in many patients. As research continues to refine and improve this therapy, it is likely to remain an important consideration in the comprehensive management of knee osteoarthritis.

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.