What is Viscosupplementation?
Safe Treatment for Arthritis of the Knee
Viscosupplementation is a nonoperative and safe FDA approved treatment for arthritis of the knee. It is very successful in those with early arthritis but is also sometimes successful in those with advanced arthritis. The pain of arthritis is dependent upon a variety of factors, not simply on the extent of the progression of disease. Radiographs of arthritis have never been directly correlated with actual pain experienced by a patient, therefore, even in advanced arthritic knees one should try viscosupplementation.
The viscosupplementation used for knee arthritis is typically hyaluronic acid. This is a naturally occurring substance in the body and it is in high concentration in the joints. Historically, the injectable form was extracted from rooster combs and made into a gel. Today, the gel is produced in biologic laboratories. It acts as a cushion in the joint and lubricates the joints. There may be a change in the body response to injury once hyaluronic acid is injected as well. Hylauronic acid aggregates with different proteins (aggrecan monomers) and this allows it to make cartilage resistant to load or compression.
There are a variety of companies that make viscosupplements for the knee and you should discuss the options with your physician. Each company’s product has pros and cons and the choice is often dependent upon the surgeon’s comfort level with a product and the patient profile.
Affect Knee Cartilage
Viscosupplementation is a way to affect cartilage in a way that benefits the patient. The supplement is a gel that is injected directly into the knee. Your surgeon may utilize ultrasound to ensure the accuracy of the injection. Some surgeons prefer to inject blindly without guidance however. The supplement is formed of hyaluronic acid; this is essentially a component of cartilage. It works by increasing the viscosity of the joint fluid and protecting the cartilage from impact. It also acts as an anti-inflammatory for the knee. Finally, the supplement provides essential building blocks for the repair of cartilage.
MRI Results after Treatments
Recent advanced MRI imaging studies of cartilage before and after viscosupplementation have demonstrated that some areas of cartilage at the patellofemoral interface actually improve on imaging after supplementation. In addition, the pain and knee function scores improved at 3 months. Placebo controlled studies have also demonstrated the effectiveness of such treatment for knee arthritis. A meta-analysis of many studies found that viscosupplementation had only a marginal benefit over placebo.
Nonoperative Treatment of Osteoarthritis
There are many nonoperative ways to treat osteoarthritis of the knee. Viscosupplementation is an FDA approved injection therapy that seems to be very effective, particularly for early arthritis. Discuss this option with your surgeon if you have arthritis and pain in the knee.
Shah RP, Stambough JB, et al. T1rho magnetic resonance imaging at 3T detects knee cartilage changes after viscosupplementation. Orthopedics. July 2015 38(7)
Manfred W, Dickhut A, et al. Viscosupplementation with Hylan G-F 20: A 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther. Jay-June 1998; 20(3):410-23.
Grace HL, LaValley M, Et al. Intra-articular hyaluronic acid in treatment of knee osteoarthritis; a meta-analysis. JAMA. 2003;290(23):3115-3121