Cartilage is a connective tissue that covers the ends of bones within a joint. Osteoarthritis oa is a disabling disease that produces severe morbidity reducing physical activity. A natural lubrication fluid called synovial fluid resides in each joint, including the knee. It is in the 7 august 2012 issue of annals of internal medicine volume 157, pages 180191. Viscosupplementation for osteoarthritis of the knee william t. The purpose of this analysis was to determine the clinical significance of injectable hyaluronic acid ha in the treatment of knee. Although there is no cure for osteoarthritis, there are many treatment options available to help people manage pain and stay active. Formulations are classified as crosslinked or noncrosslinked and are further defined. A 67yearold woman with rightknee osteoarthritis is referred by her primary care physician for treatment of. Viscosupplementation for knee osteoarthritis cleveland clinic. Viscosupplementation for osteoarthritis of the knee nejm. Viscosupplementation for knee osteoarthritis zychowicz. Viscosupplementation for knee osteoarthritis osteoarthritis is a joint disease affecting millions of americans. Viscosupplementation for the treatment of osteoarthritis of the knee n bellamy, j campbell, v robinson, t gee, r bourne, g wells contact address.
List the pathophysiologic factors involved in osteoarthritis oa of the knee, with particular focus on the older, functionally active patient population. Ha is found naturally in synovial fluid and is believed to lubricate and protect articular cartilage. It is a viable option in younger patients with less severe disease, but further investigations are still required. Use of viscosupplementation for knee osteoarthritis. Viscosupplementation formulations differ in their origin, method of production, molecular weight, treatment schedule, and physicochemical properties.
Viscosupplementation is a procedure for patients with osteoarthritis oa of the knee. Viscosupplementation for osteoarthritis of the knee. Experiences of viscosupplementation for knee osteoarthritis. Viscosupplementation for knee osteoarthritis cadth. Viscosupplementation for the osteoarthritis of the knee. Viscosupplementation for the treatment of osteoarthritis. Vladimir bobic consultant orthopaedic knee surgeon chester knee clinic the grosvenor nuffield hospital chester united kingdom. Clinically, ha may improve symptoms of osteoarthritis and delay time to total knee replacement surgery. Viscosupplementation should be limited to patients who are. Another treatment option is a procedure called viscosupplementation. In viscosupplementation, a gellike fluid called hyaluronic acid is injected into the knee joint. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads. Coverage for viscosupplementation hyaluronate injections varies across plans.
Although there is no cure for osteoarthritis, there are many treatment options available to help people. Hyaluronic acid viscosupplementation patient education. There are no cures for osteoarthritis, so viscosupplementation will not cure osteoarthritis of the knee. Aug 07, 2012 the full report is titled viscosupplementation for osteoarthritis of the knee. Pdf viscosupplementation for osteoarthritis of the knee. Injections of hyaluronate for viscosupplementation have been used i. Hyaluronic acid viscosupplementation and osteoarthritis. Viscosupplementation an overview sciencedirect topics. In this procedure, a gellike fluid called hyaluronic acid is injected into the knee joint. It is a degenerative condition involving cartilage and synovial fluid. If you have tried all other nonsurgical treatment methods and your pain continues to limit your activities, viscosupplementation may be an option. However, it is thought that hyaluronate will improve the lubricating properties of the synovial fluid, reduce the pain from. Dec 12, 2011 viscosupplementation is becoming a popular treatment for knee arthritis. A patient s guide to viscosupplementation for osteoarthritis.
Searching the cochrane central register of controlled trials from inception, medline from 1966 and embase from 1980 were searched without language restrictions to january 2012. Patients with oa have pain that typically worsens with weightbearing and activity and improves with rest. Viscosupplementation for osteoarthritis of the knee jmcp. Amssm scientific statement concerning viscosupplementation. Viscosupplementation is a procedure in which a thick fluid called hyaluronate is injected into the knee joint. The role of elastoviscosity in the efficacy of viscosupplementation for osteoarthritis of the knee. Nicholas bellamy, professor and director, medicine, centre of national research on disability and rehabilitation. Hyaluronans, viscosupplementation for osteoarthritis of the knee. The injection of hyaluronic acid often termed viscosupplementation or ha injection was. Osteoarthritis of the knee is one of the leading causes of disability in the united states.
Viscosupplementation with injections of hyaluronans has are indicated when nonpharmacologic and simple analgesics have failed to relieve symptoms e. Synvisc or synviscone j7325 for osteoarthritis of the knee will continue to be covered without prior authorization for advantage and elite. Our position statement on treatment of knee oa with viscosupplementation injection hyaluronic acid, ha versus steroid intraarticular corticosteroids, ias and placebo intraarticular placebo, iap is based on the evaluation of treatment effect by examining the number of participants. Viscosupplementation for the treatment of osteoarthritis of. Osteoarthritis oa is the most common form of chronic arthritis worldwide. Because nurse practitioners nps can inject viscosupplements, a section on injection technique is included. Abstract osteoarthritis oa is a major cause of disability. Review available nonsurgical treatment options for oa of the knee. Hyaluronan and hylan ha products provide opportunity to treat oa in individual knee joints. Summary with critical appraisal viscosupplementation for knee osteoarthritis 4 key findings there is a substantial body of evidence investigating viscosupplementation with hyaluronic acid ha in adults with knee osteoarthritis oa, but the evidence to support its efficacy is conflicting.
Efficacy and safety of intraarticular hylan or hyaluronic acids for osteoarthritis of the knee. Pdf viscosupplementation, the intraarticular injection of hyaluronic acid, is widely used for symptomatic knee osteoarthritis. Viscosupplementation for the treatment of osteoarthritis of the knee. To assess the benefits and risks of viscosupplementation for adults with symptomatic knee osteoarthritis. To provide an overview of the diagnosis and pathophysiology of osteoarthritis oa, and to describe appropriate treatments for knee oa, with a focus on the efficacy and safety of viscosupplementation. Intraarticular hyaluronic acid injection in osteoarthritis of the. Intraarticular distribution and residence time of hylan a and b. Bellamy n, campbell j, robinson v, gee t, bourne r, wells g. Utilization of viscosupplementation in the treatment of knee. The role of viscosupplementation with hylan gf 20 synvisc in the treatment of osteoarthritis of the knee. From an economic point of view, there are increasing numbers of studies demonstrating that if viscosupplementation is incorporated into treatments for knee osteoarthritis, it may present a good costeffectiveness relationship, including the capacity to delay a total knee arthroplasty29, 30, 31. As rehabilitation and fitness specialists, it is important to have a clear understanding of what viscosupplementation is and what it means for our patients and clients that may be dealing with knee osteoarthritis. It is a viable option in younger patients with less severe disease, but further investigations.
Aug 07, 2012 viscosupplementation may provide little if no pain relief or function improvement in patients with symptomatic knee osteoarthritis. Viscosupplementation for osteoarthritis of the knee introduction hyaluronic acid ha, also known as sodium hyalruonate or hyaluronan, is a viscoelastic substance composed of longchain polymers of repeating naglucuronatenacetylglucosamine disaccharide units. A 67yearold woman with osteoarthritis of the right knee seeks guidance regarding the possible benefit of hyaluronate injection. Viscosupplementation for knee osteoarthritis annals of. Viscosupplementation for knee osteoarthritis request pdf. R2, r3, r4, r5, r6 what is the role of viscosupplementation for treating osteoarthritis of the knee. The mechanism of action by which viscosupplementation alleviates arthritic knee pain is a subject of debate. Viscosupplementation treatment for knee arthritis orthoinfo. Based on the grades of recommendation assessment, development and evaluation grade approach, viscosupplementation for knee osteoarthritis provides a probable pain reduction and improvement of physical function with a lowrisk of harm 4, 9, 29. Osteoarthritis of the knee is a chronic disability that affects millions of patients worldwide. It develops slowly and the pain it causes worsens over time. Identify placement of viscosupplementation on a treatment algorithm for oa of the knee.
Rutjes aw1, juni p, da costa br, trelle s, nuesch e, reichenbach s. The effectiveness of hyaluronic acid intraarticular injections in managing osteoarthritic knee pain. Additionally, future directions for the use of hyaluronic acid and areas of active research are discussed. It also seems to increase the risk for adverse events. Failure to address the long term sequelae of knee osteoarthritis was evident in this study. Viscosupplementation for the treatment of knee arthritis. Intraarticular injections for osteoarthritis of the knee. On the basis of these findings, the authors discourage the use of viscosupplementation for knee osteoarthritis. Given the limited and inconsistent data available, use of viscosupplementation for joints other than the knee is not considered medically necessary while multiple brands of viscosupplementation are commercially available, theres no evidence, to date, that any have superior efficacy or safety for the treatment of osteoarthritis of the knee. Total hip replacement rate in a cohort of patients affected by symptomatic hip osteoarthritis following intraarticular sodium hyaluronate mw. The authors concluded that the benefit of viscosupplementation on pain and function in patients with symptomatic osteoarthritis of the knee was minimal or nonexistent and their use should be discouraged because of increased risks for serious local adverse events. Viscosupplementation treatment for knee arthritis osteoarthritis of the knee is one of the leading causes of disability in the united states.
Viscosupplementation for the osteoarthritis of the knee dr. Viscosupplementation using other brands j7320j7324, j7326j7328 for osteoarthritis of. Rutjes aw, juni p, da costa br, trelle s, nuesch e, reichenbach s crd summary. Nov 12, 20 based on the grades of recommendation assessment, development and evaluation grade approach, viscosupplementation for knee osteoarthritis provides a probable pain reduction and improvement of physical function with a lowrisk of harm 4, 9, 29. Hyaluronans, viscosupplementation for osteoarthritis of. All five agents are fda approved as biologic devices and are approved in patients with oa of the knee who have not responded sufficiently to nonpharmacologic interventions as well as simple analgesics. Clinical guideline viscosupplementation for osteoarthritis. Synovial fluid is a gel type substance which provides lubrication in the joint space.
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