Viscosupplementation for Osteoarthritis

Viscosupplementation for osteoarthritis refers to the injection of a hyaluronan preparation into the joint affected with osteoarthritis. Hyaluronan is a natural substance present in the joint fluid that assists in lubrication. It allows smooth movement of the cartilage-covered articulating surfaces of the joint. When you have osteoarthritis, the hyaluronic acid in the affected joint thins. Viscosupplementation or injection of hyaluronic acid adds to your joint’s natural supply.

Disease Overview

Osteoarthritis, also called degenerative joint disease, is the most common form of arthritis. It occurs most often in the elderly. This disease affects the cartilage at the ends of bones in a joint. In osteoarthritis, the cartilage becomes damaged and worn-out, causing pain, swelling, stiffness and restricted movement in the affected joint.

There is no cure for osteoarthritis. However, viscosupplementation may be recommended to improve the lubricating properties of the synovial fluid and help decrease joint pain, improve mobility, and offer a more comfortable level of activity.

Indications

Viscosupplementation is indicated in the management of shoulder, knee, hip and ankle osteoarthritis that has not responded to non-surgical treatment options such as pain medications, physical therapy, and corticosteroid injections. It provides symptomatic relief and can delay the need for surgery. It is injected directly into the joint to replenish the diminished synovial fluid, thereby enhancing its lubricating properties. A single dose or a total of three separate doses, over several weeks, may be required for optimum benefit.

Preparation

Preparation for viscosupplementation for osteoarthritis may involve the following steps:

• A thorough history and physical examination
• Routine blood work and imaging
• Informing your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease
• Informing your doctor of any allergies to medications or anesthesia
• Refraining from medications such as blood thinners, aspirin, or NSAIDs, if indicated
• Arranging for someone to drive you home after the procedure

Procedure

In general, the viscosupplementation procedure for osteoarthritis is performed in a clinical setting and may include the following:

• Your doctor will first clean the site of the injection with an antiseptic.
• Local anesthesia will be injected around the treatment area.
• Imaging guidance may be used by your doctor to inject the targeted site.
• Any excess fluid will be aspirated from the joint if necessary.
• Your doctor will then inject the hyaluronic acid preparation into the joint affected with osteoarthritis.
• The injected preparation not only supplements the hyaluronan in the joint but also stimulates the production of new hyaluronan. You will experience gradual symptomatic relief over the course of the injections which can last for several months.
• Finally, a bandage will be placed on the injection site.

The whole procedure usually takes only a few minutes.

Post-procedure care

Some patients may experience mild pain, swelling, warmth and redness at the injection site for up to 48 hours following a viscosupplementation injection. Headache and joint stiffness may also occur in some cases. Ice packs and analgesics (pain-relievers) may be used, if required, to ease the discomfort. Any strenuous activity should be completely avoided for 48 hours to a week after the injection based on your doctor’s advice.

Risks and Complications

Viscosupplementation is a relatively safe procedure; however, as with any procedure, some risks and complications may occur, such as:

• Pain
• Swelling
• Bleeding
• Infection
• Redness
• Bruising around the joint
• Rash and itching
• Fluid accumulation in the joint
• Allergic reaction

Summary

Viscosupplementation for osteoarthritis is a procedure where a thick fluid called hyaluronate is administered into the joint to provide symptomatic relief from osteoarthritis. Viscosupplementation is typically reserved until other conservative treatment options have been tried and have failed to relieve your pain. Usually, 3 to 5 injections, each one week apart, are needed for optimum results.