Viscosupplementation is a fairly new medical treatment with a therapeutic goal to restore rheological homeostasis in pathological structures such as the osteoarthritic joints. When the normal viscoelasticity of solid tissue compartments, or the elastoviscosity of a liquid tissue compartment, is introducing viscosupplementary devices, the normal rheological state of the compartment is restored. The devices stay in the tissue for a long period of time, depending on the nature of the viscosupplement and the pathophysiology of the compartment.
Viscosupplementation, with hyaluronic acid (HA), is a common treatment for degenerative osteoarthritis (OA), which happens when both molecular weight and concentration of HA have a major impact on its rheological properties. Pain in the knees is most commonly spotted in orthopedic outpatients in clinical settings, as well as in older populations.
Bursitis of the joints, which is found in the knees, can compress the tissue of the joints when volumes of synovial fluid gather and cause pain in the joint region. Supra-patellar is associated with knee pain out of all the bursae. Treatment for controlling supra-patellar bursitis includes a steroid injection in the bursa.
If supra-patellar pain is initially caused from degenerative disorders, viscosupplementation treatment may take effect from injecting HA into the bursa.
Changes in the fluid are unexplored and studies are focused on the identification of changes in overall protein count along with individual proteins that go along with supra-patellar. Objectives of other studies have been to evaluate the effectiveness of a double HA prep with great care to pain reduction, improved joint function and concomitant medication consumption reduction.
Study Shows Improved Protein Densities in Treatment Groups
One study had a group of 20 patients that were divided in half. One group received a high molecular HA Synvisc Hylan (G-F 20), while the second had a low molecular HA Hya-Joint Fluid, one time per week. This was injected into the bursa for the duration of three weeks total. Major changes were recorded including decreasing of the synovial fluid and overall protein concentration after the second dose of high molecular HA injections.
Apoliprotein (A-I), interleukin 1, alpha antirypsin, and matric metalloproteinase 1 protein all recorded patterns of decreasing wester immunoblotting densities after HA injections. The decrease in Apolipoprotein (A-I) and interleukin beta protein densities were major findings in the high molecular HA injection group.
Transthyretin protein, complement 5 protein and matrilin 3 protein were recorded, showing a pattern of increasing Western immunoblotting densities after HA injections. They also showed major increases in protein densities of high and low molecular HA injection groups.
Researchers Find Three-Weekly Regimen Most Effective
Another study used 108 patients with knee osteoarthritis that were randomized into two groups: “single” (S) and “weekly” (W). The “S” patients went under a procedure of only 6ml of sodium hyaluronate and 1ml triamcinolone hexacetonide, while the “W” patients underwent three applications of 2ml sodium hyaluronate with a week between.
The first application was infiltrated with 1ml (20mg) of Triamcinolone Hexacetonide. Both groups were assessed before, at one month, and three months after the applications by responding with the WOMAC, Lequesne, IKDC, and VAS questionnaires.
The first study’s results could provide targets for many biomarkers that go along with lipid transportation, inflammation, and the process of aging. The second study’s results showed no statistical difference between the single application of 6ml of sodium hyaluronate and the other application with three weekly injections. Only one patient showed major improvements in pain, which was recorded using the WOMAC pain and the VAS. The results showed that both applications improved application function, but three-weekly regimen of 2ml was more effective in reducing pain.
Another study that used 521 males and 693 females, with the mean age of 62.4 years old with OA, showed results of major pain reduction in VAS, joint improvement, and concomitant medication reduction. Patients also consumed less concomitant medications after treatment and the effects were maintained for up to six months.
Based on all these clinical research studies, it appears that viscosupplementation is an effective treatment measure for knee osteoarthritis. According to the Centers for Disease Control and Prevention (CDC) this condition affects nearly 50% of people by the age of 85 years, and 66 percent of obese people have symptomatic knee arthritis during their lifetime.
In 2009, 50% of adults in the United States 65 years or older reported having an arthritis diagnosis. While the most common form of arthritis is osteoarthritis, other common types are rheumatoid arthritis, gout, and fibromyalgia-related arthritis.
Dr. Sumit Dewanjee with FXRX is one of the top knee doctors in Phoenix and Scottsdale. He is Board Certified, Fellowship Trained and has received the Patients Choice Award 5 years in a row!
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