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Joint Fluid Therapy (Viscosupplementation)

Viscosupplementation

Joint fluid therapy, or viscosupplementation, has long been an option for those suffering from osteoarthritis. There are many products available on the market, which have differing molecular makeup, but all have similar mechanism of action. Some use synthetic hyaluronic acid while others use an avian base. The injection of intra-articular hyaluronic acid can help relieve osteoarthritis (OA) pain by re-lubricating the joint and releasing proteins that help the body produce its own natural synovial, or joint, fluid.

The goal of joint fluid therapy is to give the patient relief for a period of time but ultimately it does not fix the underlying OA. Many patients, however, would like to avoid joint replacements, or cannot afford the cost of regenerative medicine. Viscosupplementation offers these patients an option for an insurance-covered procedure that can help extend the life of the joint with low risk of complications. Those who have chicken and egg allergy should only be given products with synthetic hyaluronic acid. If you have this allergy please discuss it with Dr. Stiene.

Each patient has a differing length of time of relief from these products. To keep the positive effects of these medications viscosupplemtation injections can be repeated every 6-12 months. This is because they do not have the same deleterious effects of repeat corticosteroid injections; which have been shown to cause further breakdown in the joint.

As of now, in the United States, joint fluid therapy is only approved and covered for use in the knee. However patients with OA of the hips, shoulders, and ankles can benefit from this procedure as well. If you are interested in this please discuss the options at your visit with Dr. Stiene.

PRP and Viscosupplementation

An article published in the Journal of Stem Cells and Regenerative Medicine in 2016 by Lana et al, examined three different courses of treatment: Joint fluid therapy alone, PRP alone, and a combination of the two. The results show promising data for the use of PRP and viscosupplementation together. This randomized, double-blind, controlled trial produced results that show that HA alone is beneficial, PRP alone is beneficial as well, even more so, and that the combination of HA and PRP produced the best and longest lasting results of the three interventions.  The authors believe that the lubrication and extracellular matrix support that is provided by the HA creates an environment that allows the PRP to have an earlier effect, therefore allowing for better rehabilitation and quicker return to activities of daily living.

Lana JFSD, Weglein A, Sampson S, Vincente EF, et al. Randomized control trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee. J Stem Cells Regen Med 2016; 12(2):69-78.

 

Talk to Dr. Stiene about your treatment options. He tailors treatment to each individual patient. He may recommend Visco, PRP, or a combination of these therapies for the treatment of your OA.