Joint pain, particularly that associated with osteoarthritis, is a widespread issue impacting millions of individuals globally. Osteoarthritis, a degenerative joint disease, causes pain, stiffness, and reduced movement, often worsening with activity. While various treatments aim to alleviate these symptoms and improve joint function, viscosupplementation offers a specific approach for managing discomfort and enhancing mobility.
Defining Viscosupplementation
Viscosupplementation is a medical procedure involving the injection of a gel-like substance directly into a joint. This substance is primarily hyaluronic acid (HA), a naturally occurring component found in the body. In healthy joints, hyaluronic acid is a key ingredient of synovial fluid, a thick, stringy fluid that lubricates and cushions the joint during movement. Hyaluronic acid acts as a lubricant, enabling bones to move smoothly over each other, and as a shock absorber, distributing loads evenly within the joint.
Osteoarthritis leads to the breakdown and reduction of this natural hyaluronic acid within the affected joint. As a result, the synovial fluid loses its viscoelastic properties, becoming less effective at lubricating and cushioning the joint. This compromised joint fluid contributes to increased friction, pain, stiffness, and diminished joint function. The goal of viscosupplementation is to replenish the hyaluronic acid in the joint, aiming to restore the natural lubricating and shock-absorbing qualities of the synovial fluid.
The Administration Process
Viscosupplementation injections are administered directly into the affected joint, most commonly the knee, in an outpatient setting. The procedure begins with the healthcare provider cleaning the injection site with an antiseptic solution to maintain sterility. A local anesthetic may be injected into the area around the joint to numb it.
If there is excess fluid causing swelling in the joint, the provider may remove a small amount of this fluid before administering the hyaluronic acid. Imaging guidance is used to ensure precise placement of the needle directly into the joint space. This guidance helps to maximize the effectiveness of the injection by ensuring the substance reaches its intended target. The hyaluronic acid is then slowly injected into the joint.
After the injection, a small bandage is applied to the site. Patients are able to return home immediately following the procedure. It is recommended to avoid strenuous activities for at least 48 hours after the injection to allow for proper healing and to prevent the injected fluid from being displaced. Mild soreness, discomfort, or swelling at the injection site are common temporary reactions that resolve within a few days. Some patients receive a single injection, while others may require a series of three to five injections over several weeks.
Patient Candidacy
Viscosupplementation is considered for individuals experiencing knee pain due to osteoarthritis, particularly those with mild to moderate forms of the condition. It is recommended when conservative treatments have not provided sufficient relief. These prior treatments include physical therapy, activity modification, weight loss, and oral pain relievers. Viscosupplementation serves as an option for patients who have exhausted these less invasive methods.
The procedure is not a first-line treatment but rather an alternative for those seeking to delay or avoid knee replacement surgery. Individuals with severe osteoarthritis, characterized by significant joint damage or “bone-on-bone” conditions, are not considered ideal candidates, as the treatment is less likely to be effective in advanced stages. Contraindications for viscosupplementation include known hypersensitivity or allergies to hyaluronic acid products, active joint infections, or skin diseases in the area around the injection site.