Table 5.
Level of Consensus on Retreatment in Case of Adverse Reaction with Viscosupplementation.
| Issues on Viscosupplement and Techniques of Injection | Level of Consensus | Agreement |
|
|---|---|---|---|
| Agree | Disagree | ||
| Do you think the following differences between marketed viscosupplements could influence the clinical results? | Strongly in favor | 9 | 1 |
| Origin (animal or bacterial) | Weakly against | 5 | 5 |
| Injected volume | Strongly in favor | 8 | 2 |
| HA concentration | Moderately in favor | 7 | 3 |
| Total amount of HA | Moderately in favor | 8 | 2 |
| Molecular weight of HA | Strongly in favor | 8 | 2 |
| HA structure (linear, cross-linked) | Strongly in favor | 8 | 2 |
| Rheological properties of the gel (viscosity, elasticity, crossover frequency) | Moderately in favor | 7 | 3 |
| Mannitol or sorbitol addition | Moderately in favor | 8 | 2 |
| Do you think the dosing regimen must be supported by evidence-based-medicine? | Unanimously in favor | 10 | 0 |
| Do you agree with these assertions? | |||
| Only cross-linking allows a “single injection” regimen? | Unanimously in favor | 10 | 0 |
| Repeated injections (minimum 3) are always necessary for viscosupplements made of linear HA? | Strongly in favor | 8 | 2 |
| What imaging technique(s) do you consider before any new course of injection? | |||
| Standard X-rays | Moderately against | 4 | 6 |
| MRI | Strongly against | 1 | 9 |
| Ultrasonography | Unanimously against | 0 | 10 |
| How to ensure the intra-articular administration of the viscosupplement? | |||
| Imaging guidance | Moderately in favor | 7 | 3 |
| Synovial fluid aspiration | Strongly in favor | 9 | 1 |
| Absence of pain at injection | Weakly against | 4 | 6 |
| Lateral mid-patellar route of injection | Strongly in favor | 9 | 1 |
| Physician experience | Strongly in favor | 9 | 1 |
HA = hyaluronic acid; VS = viscosupplementation; OA = osteoarthritis; MRI = magnetic resonance imaging.