Viscosupplementation

Intra-articular injections with viscous and elastic properties essential for the mobility of arthritic joints (6).
What is viscosupplementation ?

RHEOLOGICAL BEHAVIOR : the key parameter to articulation supplements

The synovial fluid  is a biological fluid highly concentrated in hyaluronic acid. This liquid is physiologically present in the joint and assumes both biological and physical functions essential for the joints. Depending on the mechanical stresses on the joints, the synovial fluid limits the friction between the bone parts thanks to its lubricating power and absorbs shocks thanks to its cushioning power. The synovial fluid's viscoelastic properties are due to the high concentration of hyaluronic acid. From a biological point of view, synovial fluid provides the nutrients and oxygen necessary for chondrocytes. In case of osteoarthritis, the biological and physical characteristics of the synovial fluid decline (2)(3)(4).

The rheological study of the synovial fluid analyzes its deformation and its flow under the effect of applied stresses. This study shows that the synovial fluid is a viscoelastic fluid. At low frequency, for example when walking, the synovial fluid behaves like a viscous and lubricating fluid whereas, at high frequency, its absorbs shocks.

Viscosupplementation is a therapeutic approach in case of osteoarthritis that consists in supplementing the deficient synovial fluid by injecting into the affected joint a hyaluronic acid gel with similar properties to that of the healthy synovial fluid. The clinical bibiography on viscosupplementation shows that this therapeutic approach reduces pain and stiffness, helps to restore joint mobility and may delay the need for surgery (1)(5)(6).

(1) E. Maheu_Efficacy and safety of hyaluronic acid in the management of osteoarthritis:Evidence from real-life  setting trials and surveys._Seminars in Arthritis and Rheumatism_2016_volume 45_https://doi.org/10.1016/j.semarthrit.2015.11.008
(2) P. Pustejovska_Biochemical and mechanical processes in synovial fluid –modeling, mathematical analysis and computational simulations_ Univerzita Karlova v Praze_2012
(3) J. Schurz_Rheology of Synovial Fluids and Substitute Polymers_Journal of Macromolecular Science_1996
(4)E. Balazs_The physical properties of synovial fluid and the special role of hyaluronic acid_Helfet AJ, editor-Disorders of the knee_2nd edition_JB Lippincott_Philadelphia_1982
(5) N. Bellamy, and al._Viscosupplementation for the treatment of osteoarthritis of the knee_Cochrane Database Syst Rev_2006 
(6) Miler and al._US approved IA HA injections are safe and effecitives in patients with knee OA: systemic review and meta analysis of randomized, saline-controller trial_Clin Med Insights Arthritis Musculoskelet Disord_2013