Viscosupplementation PDF Print E-mail


Viscosupplementation is a procedure in which hyaluronic acid is injected into a joint. This is one of the accepted treatment methods for osteoarthritis. Studies have shown that viscosupplementation may provide for better joint lubrication, improves the shock absorbing of the joint, has pain relief properties, and may have chondro-protective functions.

In order to better understand the role that viscosupplementation does to the joint, it is important that we first understand how a joint functions. A joint is composed of the ends of two bones that are covered in a very smooth tissue called cartilage. The friction between these two opposing cartilaginous surfaces is one-fifth less than that seen with ice on ice. In order to provide for an even smoother motion, a viscous fluid is produced by the joint. This fluid, called synovial fluid, is interspersed between the cartilaginous ends of the bone. However, in addition to lubricating the joint, synovial fluid also acts as a shock absorber within the joint, dampening the effect of any sudden load on the cartilage.

In osteoarthritis, there is damage to cartilage. In addition, the synovial fluid is not as thick as it used to be. Thus, the synovial fluid loses its ability to act as a lubricant to joint motion and to act as a shock absorber within the joint. This leads to greater cartilage damage and eventual worsening of the osteoarthritis.
With viscosupplementation, hyaluronic acid, which is found in high concentrations in synovial fluid, is injected into an arthritic joint. This results in better lubrication of the joint and an improvement in the shock absorbing capabilities of the joint. However, aside from these benefits, it has also been shown that viscosupplementation provides other benefits as well, such as pain relief and a possible protection against further cartilage degeneration. Pain is decreased by a direct action on the pain receptors in the joint while cartilage protection is due to an effect on those genes that are thought to be responsible for progression of osteoarthritis.

Viscosupplementation is given to those patients who are not satisfied with the present treatment that they are receiving, such as intake of medications and physical therapy. It is most effective when cartilage damage is mild or even moderate. The success rate may be as high as 70 percent. The side effects include local reactions at the injection site, although severe reactions are rare. There are various hyaluronic acid preparations in the Philippines. Depending on the brand, one will require anywhere from 3 – 5 weekly injections into the joint. Although any joint may theoretically be treated, majority of the published studies were done with injections into the knee joint.

In summary, there is evidence that viscosupplementation with hyaluronic acid may reduce osteoarthritic pain and improve joint function. However, although pain relief may last for several months, it may take a few weeks before these effects are felt.

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