Osteoarthritis is the degeneration and breakdown of cartilage that leads to inflammation in a joint. Pain develops from the arthritic inflamed joint and can occur on a chronic persistent basis but it can also be aggravated by flare-ups associated with activity. As the cartilage wears away there is less cushioning in the joint to protect the ends of the bones from impact and other stresses associated with activity. The naturally occurring fluid in the joint (synovial fluid) also changes with arthritis and loses its lubricating and cushioning properties due to the inflammation and cartilage breakdown products that alter the chemical environment within the joint.
Although we think of arthritis as being a problem associated with old age, this is not necessarily the case. Injuries to a joint can start the process of cartilage breakdown and develop arthritis several years later. Thus a knee injury as a teenager can lead to arthritis in your twenties. It is not uncommon for the teenage soccer player with the ACL tear or the basketball player with a meniscal tear or volleyball player with a shoulder dislocation to develop arthritis within a few years. The swelling, stiffness and pain of arthritis can significantly impact their ability to participate in their sport and even simply enjoy everyday activities. Viscosupplementation can alleviate these symptoms.
Viscosupplementation is the injection of hyaluronic acid (HA) into a joint. HA is already present in the joint but the concentration diminishes as arthritis develops. By injecting HA back into the joint we can improve the cushioning and lubricating properties, and reduce the effects of inflammation and cartilage breakdown products thus alleviating symptoms. Over 90% of patients with early arthritis will get significant relief with viscosupplementation.
There are several different brands of viscosupplements including Euflexxa, Synvisc, Hyalgan, Supartz and Orthovisc. Each of these products has subtle differences in terms of HA concentration, viscosity, number of injections required and side effect profile. These injections can be used in almost any joint and are particularly effective for use in the knee, hip, ankle and shoulder. Proper placement of HA into the joint is essential in order to obtain beneficial effects. Therefore, sometimes ultrasound guidance or other imaging may be used.