Using Viscosupplementation to Treat Knee Osteoarthritis

Abstract

This article provides physicians specializing in nonsurgical sports medicine with an overview of viscosupplementation as a treatment for osteoarthritis (OA) pain. Osteoarthritis is a painful, disabling condition that is becoming more prevalent in patients and is generally treated using conservative nonpharmacologic measures. If conservative measures are unsuccessful at alleviating pain, current recommendations include prescribing acetaminophen and nonsteroidal anti-inflammatory drugs to patients. However, long-term use of these agents increases the risk for liver, cardiovascular, gastrointestinal, and/or renal complications in patients. Viscosupplementation is the term used for intra-articular injection of hyaluronic acid/hylans. Intra-articular injections of these agents have good safety profiles and have shown efficacy for treating knee OA pain. Viscosupplementation injections relieve pain for ≤ 26 weeks, which is longer than the short-term pain relief derived from nonsteroidal anti-inflammatory drugs and corticosteroid injections. Additionally, viscosupplementation administered to patients in earlier stages of OA may be more beneficial than when given later in the treatment of OA. As part of a multimodal algorithm, viscosupplementation combined with conventional therapy or other pharmacologic agents has been shown to be more effective at managing OA than conventional care alone. This article reviews the evidence for using viscosupplementation as part of a comprehensive program for managing OA in patients.

Hyaluronic acid compared with corticosteroid injections for the treatment of osteoarthritis of the knee: a randomized control trail

“…The effectiveness of pain reduction was more durable in HA group compared to CS. This was like what previous studies also provide (Ray 2013 ). At the end of the third month, pain score increased after decreasing at first and second month endpoints.…”

“…Corticosteroids are other medications used as non-expensive pain modifying intra-articular injections (Bellamy et al 2006 ), but there are no definite long-term benefits (Ray 2013 ). These two categories of intra-articular injections need to be clinically evaluated comparatively to assign their indications, contra-indications, cost-benefits and hence, to find their solid location in the algorithmic approach to the treatment of OA.…”

Randomised controlled trial comparing the intra-articular hyaluronic acid versus intra-articular steroid in osteoarthritis of knee

“…However, the effectiveness was more durable with intraarticular hyaluronic acid as compared to steroid. The results were similar to a previous study by Ray et al 21 Heyworth et al did a prospective, randomized clinical study comparing hyaluronic acid, steroid, and placebo. 22 They found that the both steroid and placebo groups showed significant pain relief for ten weeks and its effect disappeared by 12 weeks, whereas, the patients in hyaluronic acid group continue to have pain relief until 26 weeks.…”

Reduced Analgesics Consumption and Pain Intensity after Injections with a New Hyaluronic Acid in Patients with Knee Osteoarthritis

“…Intraarticular injected HA therapy shown to have prolonged effects in relieving pain compared to other similar treatments. This is consistent with other published studies to date [14,29,30].…”