Management of symptomatic osteoarthritis includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or intra-articular corticosteroids (or both), viscosupplementation, and ultimately total knee arthroplasty. In a well-executed, randomized, placebo-controlled trial, Huskisson and Donnelly have shown that viscosupplementation with a course of 5 weekly hyaluronic acid (Hyalgan) injections can relieve pain for 6 months and improve function for 4 months in relatively healthy patients with a mean age of 66 years. This study showed that the beneficial effect is at least as good as that achieved with NSAIDs but without the gastrointestinal effects.
Whereas hyaluronic acid requires 5 injections,1 hylan G-F 20 (Synvisc), another viscosupplementation agent, is effective after 3 weekly injections.2,3 Findings show that courses of hylan G-F 20 injections can be repeated every 6 months and may thus provide relief for several years.3 The study by Huskisson and Donnelly showed that injection site pain and local reactions may occur in up to 30% of patients receiving hyaluronic acid, but such adverse effects are also common with placebo injections.1 The lateral approach with a straight knee results in the fewest problems.3
The precise indications for viscosupplementation remain somewhat controversial, although patients with early arthritis and moderate symptoms seem to gain the most benefit from this intervention.
References
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