Despite the fact that preparations of an artificial synovial fluid have existed for several decades, not all orthopedists and, the more so, patients know the necessary information about these magnificent preparations. The most common questions that arise in patients before an orthopedic consultation are:

–non-surgical treatment of pain in the knee joint, is this possible?

-would the preparations of synovial fluid with the meniscus rupture?

– Treatment of arthrosis without endoprosthetics – is this likely?

-What effect of synovial fluid preparations can we expect?

– How long do synovial fluid preparations keep their effect in the joint?

– Do joint synovial fluid preparations?

– What side effects can we expect from these drugs?

– where it is better to prick intraarticularly – in a polyclinic at the surgeon, at the traumatologist in a fracture clinic, in a private clinic, in a hospital?

– How many drugs do I need?

I will answer all these questions at the end of this article.

Viscosupplement – (literal translation – extra viscosity or elasticity) – artificial prosthesis of synovial fluid – a term exists since 70-s of the last century.

 

1. The history of the use of artificial hyaluronate has about 40 years
2. Made several million artificial injections of hyaluronate
3. Injections are very simple and as safe as possible
4. Accidental introduction of artificial hyaluronate does not lead to complications
5. The basic substances used in viscosupplementation therapy – hyaluronan and  derivatives of hylan that mimic the properties of hyaluronic acid.

Hyaluronic acid and its properties:

1. Is contained in all the soft tissues of the body (eyes, joints, liquid).
2. The concentration of hyaluronan is maximal in the synovial tissue and the umbilical cord of man and much less in the skin, muscles, and other tissues.
3. Gives shape to organs and body, participating in the maintenance of tissue turgor
4. Gives the normal viscoelastic properties of synovial fluid, acting as lubricant and absorber of mechanical loads

    In osteoarthritis perform intraarticular injections different specimen of hyaluronate having different molecular weight and density – 700 000 – 1,4 million D (suplazin, fermatron, ostenil),  6 million D (synvisc,  hylan).

    The artificial introduction of hyaluronate into the joint leads to rapid relief of pain, normalization of properties of synovial fluid.

   

Indications for use of implants the synovial fluid:

1. Osteoarthritis of the large joints (elbow, hip, femoral-patellar articulation, femoral-tibial articulation, ankle joint) radiologically confirmed.
2. The chondromalacia of the articular surfaces of any degree of severity (arthroscopic identified), even in the absence of radiographic findings of osteoarthritis of this joint.
3. After arthroscopy of the joints – to speed up rehabilitation of patients.

 

 

Contraindications:

• If  the area for injection is infected or there are signs of skin diseases.
• Do not use during pregnancy or lactation.
• The drug is not recommended for children, because of the lack of information on its use in this age.

Careful application due to the deliberate reduction of efficiency:

• Synovitis
• Swelling bone marrow
• Aseptic necrosis of the condyles
• Damage of menisco-ligamentous apparatus

Of all the major joints, the greatest difficulties can arise when administering medications in the hip joint. The reasons are a sharp narrowing of the joint space, a large array of muscles and subcutaneous fat over the joint, impairing the orientation of the needle deep in the tissue. The presence of the artery on the anterior surface of the femoral head which divide the head into 1/3 and 2/3.

 

Answers to the questions at the beginning of the article:

– Non-surgical treatment of pain in the knee joint, is this possible?

Answer: Perhaps, if the cause of the pain is not bone marrow damage in the form of edema, necrosis, stress fracture.

-Can the synovial fluid preparations with a meniscus rupture?

Answer: They will help if the rupture is not accompanied by dislocation and infringement of the torn part of the meniscus.

– Treatment of arthrosis without endoprosthetics – is this likely?

Answer: Probably, only this will not be treatment, but reduction of excess friction of the destroyed joint surface and only in terms of a more comfortable expectation of the forthcoming endoprosthetics in the near future.

-What effect of synovial fluid preparations can we expect?

Answer: Reducing pain by reducing friction. Reducing the level of pain individually and drugs may not work in some cases.

-How long do synovial fluid preparations have their effect in the joint?

Answer: During the first 6 months, a strong analgesic effect can be maintained, by the end of the year approximately 50% of the pain returns.

-Do you directly medicate preparations of synovial fluid joint?

Answer: No. Only through the effect of reducing the friction manifests their main analgesic effect.

– What side effects can we expect from these drugs?

Answer: During the first 2-3 days, there is a pronounced pain syndrome and effusion in the knee joint, difficulty in flexion and full extension in the joint.

– Where it is better to prick it intraarticularly – in a polyclinic at the surgeon, at the traumatologist in a fracture clinic, in a private clinic, in a hospital?

Answer: The introduction of the drug intra-articularly simple enough, but there is a certain percentage of non-admission to the knee joint even in orthopedic hospitals and it is up to 30%. Therefore, it is desirable to administer the drug to specialists with sufficient experience of its introduction and knowing what to do in case of its failure to enter the joint and the appearance of effusion and severe pain syndrome.

– How many drugs do I need?

Answer: The amount of synovial fluid administered is individual, but is subject to general recommendations. Arthrosis of the 1st stage (according to Kosinskaya NS) – 1 injection, arthrosis of the 2nd stage – 2-3 injections, arthrosis of the 3rd stage – up to 5 injections with an interval of 1 week.

Chondromalation of 2-3 stages according to Outerbridge – from 2-3 injections, chondromalation of 4 stages according to Outerbridge – up to 5 injections.

After arthroscopy, if there is no damage to the cartilaginous cover, no more than 1-2 injections.