A minimally invasive, alternative treatment for osteoarthritic joints to relieve pain, restore function, and minimize friction between joints.
Osteoarthritis (OA) is the most common joint disease and ranks among the top ten causes of disability across the world. Unlike rheumatoid arthritis, which is a chronic, autoimmune disease that affects the lining of joints causing painful swelling, osteoarthritis is known as a degenerative—or “wear-and-tear”—disease that results in the loss of articular cartilage within joints. Articular cartilage covers the end of bones, allowing them to glide smoothly over each other during joint movement. Without cartilage, “bone-on-bone” contact usually causes painful inflammation, destruction of connective tissue (i.e., ligaments and menisci), and bone damage (2).
What is Viscosupplementation?
Viscosupplementation is a treatment option used to relieve pain and restore function in osteoarthritic joints whose symptoms have not responded to simpler non-surgical treatment methods (i.e., physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, pain relievers, and decreased physical activity) (5).
Viscosupplementation restores osteoarthritic joints with normal levels of hyaluronic acid, ultimately minimizing the restrictive and painful symptoms of osteoarthritis.
The procedure involves an injection of a gel-like fluid called hyaluronic acid (HA) into the joint. High levels of HA are naturally present in healthy, non-arthritic joints. HA acts as a lubricant and shock absorber, thereby helping to maintain the integrity of the joint and normal synovial fluid viscosity (7). In other words, HA allows joints to move pain-free through normal ranges of motion due to minimal friction between cartilage and bone at the joint articulation.
The degenerative effects of osteoarthritis result in low levels of HA, leaving joints with low viscosities and decreased elasticity. The symptoms include pain, stiffness, swelling, inflammation, and increased warmth within the joint. These symptoms can increase in severity if the patient is left untreated or is unresponsive to basic treatment methods, leading to bone spurs (osteophytes), loss of motion, and degradation of cartilage. During final stages of osteoarthritis, total joint replacement is often the last option (5,7).
Patients may experience a long-term increase in cartilage integrity after treatment.
At Pacific Coast Sports Medicine, we strive to restore function, relieve joint pain, and ultimately avoid invasive and risky surgical procedures (e.g., total knee or hip replacement). Viscosupplementation treatments are frequently an option. By injecting exogenous HA into the joint, patients usually experience pain relief and decreased inflammation due to the stimulation of endogenous HA production and increased synovial fluid viscosity within the joint. Other processes that aid in the alleviation of symptoms in response to intra-articular HA injections include the stimulation of chondrocytes (cells that produce and maintain the cartilaginous matrix within cartilage), as well as the inhibition of enzymes that promote cartilage erosion (6). It is common that these effects last six months or longer, whereby another viscosupplementation procedure may be advised if proven an effective form of treatment for the patient (8).
It is FDA-approved and has been demonstrated in the current research literature as a safe and efficacious form of treatment for those with osteoarthritis.
Examples of these clinical studies include the following:
- Seventy-six trials of viscosupplementation treatments were conducted for patients with osteoarthritic knees. After 5-13 weeks post-injection, patients’ pain improved on average from 28% to 54% and function improved 9% to 32% (3).
- In osteoarthritic patients over the age of 50 years old, viscosupplementation applied to the knee resulted in an average decrease of pain by 51.2% after six months of treatment. Adults between the ages of 50-64 were able to exercise 33.2% longer due to less knee pain. Elderly adults (65+ years) were able to exercise 7.9% longer (7).
- In a systematic review and meta-analysis looking at 29 studies representing 4,866 patients and the safety and efficacy of US-approved HA injections in patients with knee osteoarthritis, researchers concluded that “100% of reported ‘serious adverse events’ were unrelated to treatment” and that “US-approved HA products are not associated with increased safety risks” (6).
While the knee is the most common joint treated, viscosupplementation may also be applied to other joints, such as the hip or shoulder. Studies suggest that this technique has promising results post-tendon surgery, in tendinopathies, and for supra-patellar bursitis patients (1,4). Contrary to what many people think, viscosupplementation does not reverse the arthritic process.
- Abate M, Schiavone C, Salini V. The use of hyaluronic acid after tendon surgery and in tendinopathies. Biomed Res Int. 2014;2014:783632.
- Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop. 2014;5(3):351-361.
- Bellamy M, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;(2):CD005321.
- Chen CPC, Hsu CC, Pei YC, Chen RL, Zhou S, Shen HC, Lin SH, Tsai WC. Changes of synovial fluid protein concentrations in supra-patellar bursitis patients after the injection of different molecular weights of hyaluronic acid. Exp Gerontol. 2014;52:30-5.
- Holland K. Viscosupplements for OA of the knee: what you need to know. Healthline Web site. healthline.com/health/osteoarthritis-viscosupplements-for-oa-of-the-knee. Reviewed May 2, 2013. Accessed October 1, 2014.
- Miller LE, Block JE. US-Approved intra-articular hyaluronic acid injections are safe and effective in patients with knee osteoarthritis: systematic review and meta-analysis of randomized, saline-controlled trials. Clin Med Insights Arthritis Musculoskelet Discord. 2013;6:57-63.
- Vincent HK, Percival SS, Conrad BP, Seay AN, Montero C, Vincent KR. Hyaluronic acid (HA) viscosupplementation on synovial fluid inflammation in knee osteoarthritis: a pilot study. Open Orthop J. 2013;7:378-384.
- Viscosupplementation Treatment for Arthritis. OrthoInfo Website. http://orthoinfo.aaos.org/topic.cfm?topic=a00217. Last reviewed March 2014. Accessed September 30, 2014.