What is viscosupplementation. How does hyaluronic acid help with knee osteoarthritis. Who are the ideal candidates for this treatment. What are the potential side effects of hyaluronic acid injections. How long does the pain relief last after viscosupplementation. What is the recommended frequency for these injections. How does viscosupplementation compare to other osteoarthritis treatments.

Understanding Viscosupplementation: A Promising Treatment for Knee Osteoarthritis

Viscosupplementation has emerged as a notable treatment option for individuals grappling with knee osteoarthritis. This innovative procedure involves injecting a gel-like substance called hyaluronic acid directly into the affected knee joint. But why is this treatment gaining traction in the medical community?

Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding our joints. It plays a crucial role in joint health by acting as both a lubricant and a shock absorber. In people with osteoarthritis, the concentration of hyaluronic acid in their joints is lower than normal, which contributes to pain and reduced mobility.

The theory behind viscosupplementation is that by introducing additional hyaluronic acid into the arthritic joint, it can facilitate smoother movement and reduce pain. While research results have been mixed, many patients report significant pain relief and improved function after undergoing this treatment.

The Science Behind Hyaluronic Acid Injections

To truly appreciate the potential benefits of viscosupplementation, it’s essential to understand how hyaluronic acid functions within our joints. This remarkable substance has unique properties that make it invaluable for joint health:

• Lubrication: Hyaluronic acid helps reduce friction between the bones in the joint, allowing for smoother movement.
• Shock absorption: It acts as a cushion, absorbing the impact of daily activities on the joint.
• Nutrient transport: Hyaluronic acid facilitates the movement of nutrients to the cartilage, promoting its health and function.
• Anti-inflammatory properties: Some studies suggest that hyaluronic acid may have mild anti-inflammatory effects, potentially reducing joint inflammation.

When injected into an osteoarthritic knee, hyaluronic acid aims to supplement the body’s natural supply, potentially restoring some of the joint’s lost function and alleviating pain.

Available Hyaluronic Acid Preparations for Knee Osteoarthritis

Since the FDA’s approval of viscosupplementation in 1997, several hyaluronic acid preparations have become commercially available. These include:

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

Each of these preparations has its unique characteristics and injection protocols. The choice of which product to use often depends on factors such as the severity of the osteoarthritis, the patient’s individual needs, and the physician’s experience with different products.

The Viscosupplementation Procedure: What to Expect

Are you considering viscosupplementation for your knee osteoarthritis? Here’s what you can typically expect during the procedure:

1. Initial assessment: Your doctor will evaluate your knee and may use imaging techniques to guide the injection.
2. Preparation: The injection site will be cleaned and, if necessary, a local anesthetic may be applied.
3. Aspiration: If there’s excess fluid in your knee, your doctor may remove it before injecting the hyaluronic acid.
4. Injection: The hyaluronic acid is then injected into the joint space. This is usually done with a single needle, though some doctors may prefer to use separate syringes for aspiration and injection.
5. Post-procedure care: You’ll be advised to avoid strenuous activities for the first 48 hours after the injection.

The number of injections you’ll receive depends on the specific product being used. Some treatments involve a single injection, while others may require a series of three to five weekly injections.

Efficacy and Duration of Pain Relief

How effective is viscosupplementation in managing knee osteoarthritis pain? The answer isn’t straightforward and can vary significantly from person to person. While some patients report substantial pain relief and improved function, others may not experience significant benefits.

When viscosupplementation is effective, pain relief typically begins 4 to 12 weeks after the injection series is completed. The duration of relief can last for several months, with some patients experiencing benefits for up to a year.

It’s important to note that viscosupplementation is not a permanent solution. The treatment can be repeated as necessary, typically after the effects of the previous series have worn off. However, the long-term efficacy and safety of repeated treatments are still being studied.

Ideal Candidates for Viscosupplementation

Who stands to benefit most from hyaluronic acid injections? Viscosupplementation is typically recommended for patients with mild to moderate knee osteoarthritis who haven’t found sufficient relief from other non-surgical treatments. These may include:

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

Ideal candidates are those who are still experiencing significant pain and limitation in their daily activities despite trying these conservative treatments. However, it’s crucial to note that viscosupplementation may not be suitable for everyone. Your doctor will consider factors such as the severity of your arthritis, your overall health, and any allergies or sensitivities you may have.

Potential Side Effects and Precautions

While viscosupplementation is generally considered safe, like any medical procedure, it does come with potential risks and side effects. Common side effects may include:

• Pain at the injection site
• Swelling
• Heat or redness around the joint
• Temporary increase in knee pain

In rare cases, more severe reactions can occur. A condition known as pseudosepsis or a severe inflammatory reaction can happen, characterized by significant swelling, redness, and pain. While this reaction can be alarming, it’s important to note that it’s not an actual infection and typically resolves on its own or with treatment.

Certain individuals should not receive hyaluronic acid injections. These include people with:

• Skin or joint infections
• Bleeding disorders
• Certain allergies (most hyaluronic acid products are derived from rooster combs and should be avoided by those with egg or poultry allergies, though Euflexxa is safe for use in people with egg allergies)

Comparing Viscosupplementation to Other Osteoarthritis Treatments

How does viscosupplementation stack up against other treatments for knee osteoarthritis? Let’s compare it to some common alternatives:

Corticosteroid Injections

Corticosteroid injections are another type of injection therapy used for knee osteoarthritis. They work by reducing inflammation in the joint. Compared to viscosupplementation:

• Corticosteroids tend to provide more rapid pain relief
• The effects of corticosteroids typically last for a shorter duration (a few weeks to a few months)
• There are concerns about the long-term effects of repeated corticosteroid injections on joint health

Oral Medications

Oral medications like nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to manage osteoarthritis pain. Compared to these:

• Viscosupplementation is a localized treatment, potentially reducing systemic side effects
• The effects of viscosupplementation can last longer, reducing the need for daily medication
• However, oral medications are non-invasive and can be more convenient for some patients

Physical Therapy

Physical therapy is a crucial component of osteoarthritis management. When compared to viscosupplementation:

• Physical therapy can provide long-term benefits by strengthening the muscles around the joint
• It requires active participation from the patient and can be time-consuming
• Viscosupplementation can be used in conjunction with physical therapy for potentially better outcomes

It’s important to note that these treatments are not mutually exclusive. Many patients benefit from a combination of different therapies, tailored to their individual needs and response to treatment.

The Future of Viscosupplementation in Osteoarthritis Treatment

As research in the field of osteoarthritis treatment continues to evolve, what does the future hold for viscosupplementation? Several areas of ongoing investigation are worth noting:

Improved Formulations

Researchers are working on developing new hyaluronic acid formulations that may provide longer-lasting effects or better pain relief. Some areas of focus include:

• Higher molecular weight hyaluronic acid preparations
• Combinations of hyaluronic acid with other therapeutic agents
• Cross-linked hyaluronic acid formulations for increased durability

Personalized Treatment Approaches

There’s growing interest in identifying which patients are most likely to benefit from viscosupplementation. This could involve:

• Genetic testing to identify potential responders
• Advanced imaging techniques to guide treatment decisions
• Biomarker analysis to predict treatment outcomes

Combination Therapies

Researchers are exploring how viscosupplementation can be combined with other treatments for potentially synergistic effects. This might include:

• Combining hyaluronic acid injections with platelet-rich plasma (PRP) therapy
• Using viscosupplementation in conjunction with stem cell treatments
• Integrating hyaluronic acid injections into comprehensive rehabilitation programs

While these areas of research hold promise, it’s important to approach new developments with cautious optimism. Large-scale, long-term studies will be necessary to establish the safety and efficacy of these potential advancements.

Making an Informed Decision About Viscosupplementation

If you’re considering viscosupplementation for your knee osteoarthritis, how can you make an informed decision? Here are some key steps to take:

1. Consult with a specialist: An orthopedic surgeon or rheumatologist can provide a thorough evaluation of your condition and discuss whether viscosupplementation is appropriate for you.
2. Understand your options: Make sure you’re aware of all available treatment options, including conservative measures and other types of injections.
3. Consider your lifestyle: Think about how the treatment schedule and potential side effects might impact your daily activities.
4. Discuss expectations: Have a frank conversation with your doctor about what results you can realistically expect from the treatment.
5. Check your insurance coverage: Viscosupplementation can be expensive, so it’s important to understand what costs your insurance will cover.
6. Plan for follow-up care: Remember that viscosupplementation is often most effective when combined with other treatments like physical therapy.

By taking these steps, you can make a well-informed decision about whether viscosupplementation is the right choice for managing your knee osteoarthritis.

Integrating Viscosupplementation into a Comprehensive Osteoarthritis Management Plan

While viscosupplementation can be an effective treatment for knee osteoarthritis, it’s important to view it as part of a broader management strategy. How can you incorporate hyaluronic acid injections into a comprehensive plan for managing your condition?

Lifestyle Modifications

Certain lifestyle changes can complement the effects of viscosupplementation and improve overall joint health:

• Weight management: Maintaining a healthy weight reduces stress on your knees.
• Low-impact exercise: Activities like swimming or cycling can improve joint function without excessive strain.
• Proper nutrition: A balanced diet rich in anti-inflammatory foods may help manage osteoarthritis symptoms.

Physical Therapy

Working with a physical therapist can enhance the benefits of viscosupplementation by:

• Strengthening the muscles around the knee joint
• Improving flexibility and range of motion
• Teaching proper body mechanics to reduce joint stress

Assistive Devices

Certain tools can help reduce stress on your knees during daily activities:

• Braces or sleeves for added joint support
• Walking aids like canes or walkers when needed
• Shoe inserts or orthotic devices to improve alignment

Complementary Therapies

Some patients find additional relief through complementary approaches such as:

• Acupuncture
• Massage therapy
• Mind-body techniques like yoga or tai chi

Remember, the most effective osteoarthritis management plan is often multifaceted, addressing not just the symptoms but also the underlying factors contributing to joint degeneration. Viscosupplementation can be a valuable component of this comprehensive approach, potentially providing significant pain relief and improved function when combined with other therapeutic strategies.

As research continues and our understanding of osteoarthritis evolves, treatments like viscosupplementation will likely continue to be refined and improved. By staying informed about the latest developments and working closely with your healthcare team, you can make the best decisions for managing your knee osteoarthritis and maintaining your quality of life.

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.