Osteoarthritis is an arthritic condition that affects many patients we treat here at Austin Foot and Ankle Specialists. There are various ways to treat the condition, but one that can be especially beneficial is viscosupplementation. Understanding what is entailed with this treatment will help you make an informed decision about treating your arthritis.
Why Might I Need This Treatment?
Osteoarthritis is a joint disease that mainly affects cartilage, the tissue that covers the ends of bones in a joint. When healthy, cartilage allows bones to glide over one another and provides a shock-absorbing function. A healthy joint also contains a small amount of fluid (synovial fluid), which is a thick, gel-like substance necessary for cushioning the joint and providing lubrication to reduce friction.
With this condition, the surface layer of cartilage breaks down and wears away. Contributing to the problem, the synovial fluid loses its viscosity (ability to lubricate or "oil" the joint) over time. This combination of cartilage deterioration along with the loss of lubrication from synovial fluid contributes to pain and stiffness, limitation of joint motion, and some inflammation (redness and swelling) in joints.
What is Viscosupplementation?
The treatment involves an injection of a thick fluid (hyaluronate) into a joint afflicted with osteoarthritis. Pharmaceutical companies in the United States have developed three products containing hyaluronic acid—one of the two natural lubricants in synovial fluid—for injection into a joint. These are known by the brand names Hyalgan, Synvisc, and Supartz.
Will It Cure My Arthritis?
No, the procedure is not a cure. Currently, there are no cures for arthritis. The theory behind this type of treatment is that it will:
- Improve the lubricating properties of the synovial fluid.
- Reduce or stop the pain in the joint.
- Improve mobility and provide a higher and more comfortable level of activity.
Who Are Candidates for Viscosupplementation?
You might consider this treatment if you have not found pain relief from:
- Physical therapy
- Weight loss
- Use of heat (for example, from a heating pad) and cold (for example, from an ice pack)
- Use of a cane or orthotics (such as a heel wedge and other products that relieve the pressure on the joints) and
- Use of analgesics, including acetaminophen (for example, Tylenol); aspirin; prescription or nonprescription nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (for example, Advil, Motrin) and naproxen (for example, Aleve); or corticosteroid injections
Viscosupplementation might also be right for you if you cannot take aspirin or other anti-inflammatory drugs like ibuprofen, are already taking multiple medications, or are not an appropriate candidate for surgery.
What Results are Possible?
Some studies have found these products to improve the pain and function in some people with mild to moderate osteoarthritis. Of patients who have been helped by the injections, many report feeling a certain degree of pain relief during the course of the injections; whereas pain relief is delayed in others. Most patients report the greatest pain relief 8 to 12 weeks after beginning treatment. Some keep experiencing benefits for up to 6 months, and some longer.
What Are the Potential Side Effects?
The most commonly reported side effects associated with the injections are temporary injection-site pain, swelling, heat and/or redness, rash and itching, bruising around the joint and/or fluid accumulation in the injected joint.
A small study in patients receiving Hyalgan showed the viscosupplements to be well-tolerated by patients when treated every 6 months (with a complete treatment course of five injections) for up to 30 months.