Joint Lubrication (Viscosupplementation)
If you have been told by your doctor that the pain in your knee is “just a little arthritis,” you are one of approximately 70 million Americans who suffer from this degenerative joint disease. Fortunately, a variety of non-surgical and surgical treatments options are available for patients that suffer from osteoarthritis (OA).

Synovial fluid lines a healthy joint, acts as a cushion, and reduces the friction and wear from joint motion. Hyaluronic acid (HA) is a shock-absorbing and lubricating component found in the cartilage and synovial fluid of the joint. Just as cartilage wears down in osteoarthritis, the level of hyaluronic acid in the joint also decreases and loses its shock-absorbing elasticity. Intra-articular injections of hyaluronic acid are believed to stimulate increased production of lubrication in the aging, arthritic joint. This treatment is known as viscosupplementation and is one of the non-surgical options we offer to our patients for the symptomatic treatment of OA.

Joint lubrication at The Stone Clinic involves a single injection of HA called Supartz. We combine the usual three injection series into one and have found that our patients fall into three groups. The first group (30% of patients) seem to have tremendous relief lasting up to a year. The second group (30%) have a mixed response with some relief. The last group do not respond. Commercial products such as Hyalgan® (Sanofi-Aventis, Bridgewater, NJ), Orthovisc® (DePuy Mitek, Raynham, MA), Synvisc® (Wyeth, Philadelphia, PA), and Supartz® (Smith and Nephew Inc, Mississauga, Ontario, Canada) consist of a sterile mixture of sodium hyaluronate from rooster/chicken combs. If you are allergic to poultry products, you are not eligible for this procedure. Side effects may include some discomfort, pain, redness, heat, or swelling, which normally resolves after a short period. Although it is not a cure, viscosupplementation can provide temporary pain relief (months to years) and increased function and can delay the time before surgical intervention is necessary.

Recent studies suggest that viscosupplementation may provide disease-modifying benefits by slowing the progression of osteoarthritis in the joint. With the potential to decrease inflammation, reduce pain, and increase function, HA injections are being considered for both chronic pain in arthritic joints and acute pain from traumatic sports injuries as well.

When viscosupplementation is combined with an appropriate physical therapy regimen, studies have shown positive results. Hyaluronan injections in one study had more favorable results than treating osteoarthritis with naproxen, an over-the-counter, non-steroidal anti-inflammatory (NSAIDs); however, other studies have shown equivocal results.

The appropriate time to use intra-articular injections of hyaluronic acid varies from person to person. Typically, viscosupplementation is considered as an augmentation to other treatments including glucosamine, acetaminophen, or other NSAIDs. Some patients find they are able to “buy time” using viscosupplementation when they are considering surgery. We recommend viscosupplementation three to four months after any surgical cartilage regeneration procedure.

Viscosupplementation is just one of the non-surgical tools we use to treat the pain of OA and improve functioning. Surgery can often be delayed or improved when combined with muscle and trunk strengthening, gait training, range of motion exercises, joint mobilization, weight loss, increased water intake, and heel wedges.