Viscosupplementation in the Therapy for Osteoarthritic Knee

Abstract

Osteoarthritis (OA) is a degenerative disease that is spreading worldwide due to an aging population. This is not simply a disease caused by worn out joints, but a complex disease accompanied by various mechanisms such as inflammatory reactions. Among various joints, knee joints show degenerative changes earlier than other joints because they carry most of the weight load, causing social-economic problems. In the case of OA of the knee that does not respond to relatively simple conservative treatments such as physical therapy or medication, intra-articular injection is preferred. However, intra-articular injection drugs have limited effectiveness and uncertainties. There are several intra-articular viscous supplement drugs such as hyaluronic acid. Tissue regeneration active materials such as polydeoxyribonucleotide and polynucleotide are also newly used. The objective of this paper was to compare effects of intra-articular supplementation drugs used for degenerative arthritis of the knee.

Efficacy and Safety of Intra-Articular Cross-Linked Sodium Hyaluronate for the Treatment of Knee Osteoarthritis: A Prospective, Active-Controlled, Randomized, Parallel-Group, Double-Blind, Multicenter Study

“…A third limitation was that our study followed patients for a maximum of 26 weeks (6 months). Data from recent meta-analyses suggest that the effects of intraarticular HA injections in relieving pain and improving joint function can endure for up to 6 months [10,18,[35][36][37][38][39]. Cross-linked HAs are known to have increased residence time within the joint compared with non-chemically modified linear HAs [7], and therefore it would be interesting to investigate the longer-term effects of a single-dose HA in a follow-up study of its duration of effect.…”

“…Thus, when HA is injected into OA-affected joints to improve the viscoelasticity of the synovial fluid, it consequently restores the lubricating and shock-absorbing properties in the joint. This process, termed exogenous viscosupplementation, can also stimulate an increase in endogenous HA levels [10,11]. Furthermore, the injection of intra-articular HA can promote proteoglycan and glycosaminoglycan synthesis within the cartilage (including endogenous HA).…”

“…The cross-linking of linear HA increases its stability and viscosity, leading to delayed drug degradation in the body and extending the durability of a single injection [10,[19][20][21]. Multiple injections are required when HMW HA that has not been cross-linked is used, and as such, most of the intra-articular HA preparations in use today are based on a multipleinjection dosing regimen [7].…”

Effectiveness of gonarthrosis treatment via intra-articular injections of linear vs. cross-linked hyaluronic acids

“…Its initial injection was reported to be efficient and secure for 12 weeks, and injections given repeatedly at 24 weeks are efficient and secure until 36 weeks. [ 12 , 30 ]…”

“…Consequently, a single long-acting injection suffices for treatment, as supported by references. [ 12 - 14 ] In contrast, non-cross-linked HA necessitates multiple injections. [ 9 ] Furthermore, distinctions exist between these HA formulations in terms of various product attributes.…”