Prior to discussing whether it is ever too later to use a viscusupplementation, we ought to understand this medical process designed to treat osteoarthritis of the knee. The procedure entails injecting a thick fluid known as hyaluronate directly into the affected knee. In fact, osteoarthritis is a retrogressive joint ailment that affects as many as 21 million Americans and characteristically involves the weight-bearing knee and other joints. Interestingly enough, the American College of Rheumatology states that although 70 per cent of people over 70 years of age have x-ray evidence of the ailment, only half of them will actually develop the indications.

Hyaluronan or hyaluronic acid is naturally present in the joint fluids and is highly gelatinous by nature. This substance enables the cartilage surfaces of the bones to glide upon each other smoothly. When the level of hyaluronic acid in the joint fluids decreases, it results in osteoarthritis causing the synovial fluid of the joint to become thinner. This, in turn, diminishes the lubrication of the joints, thereby causing pain and immovability. In such situations, viscosupplementation becomes essential to alleviate pain as well as restore the normal functioning of the joints. Viscosupplementation may delay or even some cases completely do away with the need for total knee replacement.

Viscosupplementation with hyaluronic acid products such as Synvisc, Hyalgan, Orthovisc and others replaces the damaged synovial fluid of the joint. Viscosupplementation can improve the cushioning and lubricating effects of synovial fluid. Hence, viscosupplementation is often also known as synovial fluid replacement. Presently, several viscosupplements are available in the market and they include Synvisc, Hyalgan, Orthovisc, Neovisc, Supartz, Euflexxa, Durolane and Suplasyn. Nevertheless, the U.S. Food and Drug Administration (FDA) only approve the use of viscosupplements for knee osteoarthritis.

Viscosupplementation Candidates

Contrary to the views of some people, it is never too late to use viscosupplementation. In fact, viscosupplements can definitely be recommended where all other treatments for knee osteoarthritis may have failed to yield the desired results. Although the benefits of viscosupplementation are perhaps greatest in early osteoarthritis, these orthopedic injections can be used at any stage of the disease. The orthopedic injections may be recommended for patients who are too young for total knee replacement or given to patients who have a medical contraindication for total knee replacement when their osteoarthritis is actually in an advanced stage. Viscosupplementation is best suitable for knee osteoarthritis patients who are not receiving adequate pain relief from current treatment, cannot take aspirin or other anti-inflammatory drugs like ibuprofen, are already taking multiple medications and/ or are not an appropriate candidate for knee replacement surgery.

The most common candidates for viscosupplementation are certainly the elderly knee osteoarthritis patients. Even younger patients with mild to moderate knee osteoarthritis are also good candidates who have significant symptoms, but are not yet ready for a surgical intervention. According to researches, viscosupplementation is effective in Kellgren-Lawrence radiographic stages 1-3 and even in patients with late-stage Kellgren-Lawrence 4 knee osteoarthritis.

Treatment

In order to receive viscosupplementation a knee osteoarthritis patients needs to be assessed by a physician who is able to refer him or her to a specialist, usually a rheumatologist or an orthopedic surgeon, who can decide whether or not administering the medical injection is right for the patient. The specialist will also be able to decide which orthopedic injection is most appropriate for the patient. Viscosupplementation with Synvisc injections requires administration of a total of three orthopedic injections, one injection every week for three weeks. However, if viscosupplementation is done with medical injections, such as Hyalgan injections and Supartz injections, a total of five injections are needed – one orthopedic injection every week for five weeks. According to researches, the viscosupplements like Synvisc and Hyalgan have been proven to alleviate pain from knee osteoarthritis for up to six months. Some patients have experienced the benefit last for more than six months after taking the orthopedic injections. Supartz was shown to provide pain relief up to four and a half months following the final injection of the five medical injection series.

Side Effects

Treatment of knee osteoarthritis with viscosupplementation is not free from side effects. The most commonly reported side effects associated with these medical injections are temporary pain, swelling, heat and/or redness, rash and itching, bruising around the joint and/or fluid accumulation in the injected knee. These reactions to the orthopedic injections are usually mild, but can be severe at times. However, these side effects do not last long

Precautions

Before taking the orthopedic injections, knee osteoarthritis patients need to tell their physicians if they are allergic to any bird products like eggs, feathers or poultry. At the same time, patients having allergy to preparations with sodium hyaluronate and/ or infection or skin disorder at the injection site should not take viscosupplementation. As these medical injections are not drugs, they will not interfere with other medications, such as pain relievers or anti-inflammatory drugs that the patient might be taking. Nevertheless, it is important to keep the physician informed about the drugs that the knee osteoarthritis patient may be taking. It is advisable not to administer Synvisc, Hyalgan and Supartz to pregnant women as the safety of using these orthopedic injections is yet to be ascertained.