Viscosupplementation for Knee Arthritis

Knee arthritis is one of the leading causes of disability within the adult population. I always
recommend that patients read the NICE information guidance present under the patient information leaflets on my website.

There are many treatment modalities, one of which is the use of intra articular (within the knee)
Hyaluronic Acid (HA) injections. This is a naturally occurring molecule found within the synovial
fluid in the knee joint.

There are a number of mechanisms sited for how the Hyaluronic Acid works including condro-
protection, Proteoglycan and Glycosaminoglycan synthesis, anti-inflammatory properties,
mechanical properties with sub-chondral analgesic actions. It is felt that these actions may occur due
to the binding of the HA on specific receptors creating these biological causes.

A recent article in the British Medical Journal (BMA) looks at a large number of scientific articles to
see if intra articular injection of Hyaluronic Acid was effective in managing pain in people with
osteo arthritis.

As always, there are problems combining a number of different studies but the conclusion of the
article was that indicating that viscosupplementation was associated with a small reduction in pain
intensity compared with placebo but the difference is small.

I use Ostenil Plus in my practice, advising patients before injection on the possible benefits and
complications.