Over the past 30 years, the medical community has been working hard to invent a method that would reduce osteoarthritis of the knee caused by a loss of joint lubrication. Efforts seem to have finally been successful in producing artificial synovial fluid for this purpose. A problem doctors encountered in the initial stages was they could not use this artificial fluid as a true replacement. This is due to its lack of important features. Today, however, artificial synovial fluid has been developed and improved in its effectiveness to a notable extent. Doctors can now use it in the treatment of knee osteoarthritis patients. Results have shown that it can reduce knee pain, allow more activity and range of movement of the knee. These results may be effective for up to six months.
The body naturally produces a substance known as synovial fluid. This is a sticky, jelly-like fluid found in the joints which helps the joints to move more easily and lubricates cartilage surfaces. This helps reduce friction when bending or stretching the knee. Synovial fluid also helps to reduce pressure and absorb shock to the bone surface while walking or running.
In some conditions, like when you get older, or overwork or overuse your joints, the synovial fluid will decrease. Additionally, there may be synovial fluid abnormalities. These result in the deterioration of certain joints or even injury. Artificial synovial fluid or HA is a synthetic compound that mimics the properties of true synovial fluid. Its characteristics include the creation of lubrication in the joints and a reduction of inflammation. It also has properties as a potential substrate for the creation of increased fluid in the articular cartilage and the synovial membrane. HA injections can, therefore, help reduce joint injury.
Medical experts divide hyaluronic acid according to molecular size or weight – high molecular weight which has larger molecular sizes, medium molecular weight with medium molecular sizes, and HA with lower molecular weight and size.
Larger molecular sizes are known for their outstanding lubrication properties. While medium and low molecular sizes are known for being potential substrates for fluid in the articular cartilage and synovial membrane. Doctors will normally consider the various types of hyaluronic acid appropriate for use according to its properties along with the needs of the patient.
A clear indication for the necessity of HA injections is the presence of osteoarthritis in patient groups who are unresponsive to treatment with medication but who have not yet reached the stage of needing surgery. In other words, those who are in the middle between medication and surgical treatment.
When injected, artificial synovial fluid injections are effective for about six months. Additionally, doctors can also use it in cases of articular cartilage damage or injuries, such as knee cap injuries. They can also use it in conjunction with surgery in the form of injections following articular cartilage repair surgery. Doctors use it to help the patient recover and enjoy a faster return to the use of their injured joints.
When considering the best treatment for osteoarthritis patients, whether to use platelet-rich plasma (PRP) injections or hyaluronic acid injections must be at the discretion of the patient’s doctor. This is because there are some principal differences between the two treatment methods.
HA injections focus on the treatment of osteoarthritis patients by increasing lubricating fluid and stimulating artificial cartilage substrate. PRP injections, on the other hand, are a treatment that stimulates the repair of tissues or joints. Doctors can carry out both types of injections post-surgery. They use HA injections to help adjust fluid balance in the joints while PRP injections are used to reduce inflammation.
Both treatments may be used at the same time. However doctors do not usually inject them simultaneously as this would cause an overload on the knees. In cases where a combination of both treatments is necessary, doctors may first give artificial synovial fluid injections. After that, they would make a followup appointment with the patient for PRP injections at a later date.
Currently, however, modern HA extraction methods can significantly reduce symptoms. This makes it almost as pure as the patient’s own synovial fluid.
The amount of HA the doctor injects is based upon the patient’s condition, disease duration and the area of the joint affected. Normally, the doctor will give a course of 3-5 injections, with 1-2 injections given at a time, separated by about a week. However, it depends on the symptoms and severity of the disease as well as the type of HA the doctor is using. Today, with the latest development, doctors can use HA as an effective single-dose treatment. The advantage of this is that it is a single injection. However, the price is currently quite high compared to a course of a number of injections carried out over a period of time.
With regard to treatment results, you usually see the most obvious, actual results of the injections after approximately 4-6 weeks. However, depending on the severity of the disease, it could also take as long as six months.
There are a variety of treatments available for osteoarthritis today. Still, the medical community will always be taking strides forward, developing and creating new and up-to-date innovations and treatments. The first and most important choice, however, is always prevention. Choose to eat healthy foods beneficial to your body. Exercise in a way that is appropriate to your age and the condition of your joints. Finally, avoid any high-impact activities, especially elderly patients who have a higher risk level of joint injuries and promote their healthy potential.
M.D., Faculty of Medicine, Srinakharinwirot University, 1998