Arthrosis is a common degenerative disease of the articular cartilage.
As it affects all joint regions and especially those subjected to load, it is a cause of severe disability.
Currently, conservative (non-surgical) therapy for osteoarthritis involves the use of anti-inflammatory drugs, physiotherapy, body weight reduction and infiltrations with PRP and hyaluronic acid, PRP and (mesenchymal) stem cells.
Hyaluronic acid is a substance naturally produced by our body for the purpose of moisturising and protecting tissue. [3][4] There are different types of synthetic hyaluronic acid that are divided according to molecular weight.
The benefits of Hyaluronic Acid infiltrations are pain relief, improved joint mobility and prevention of cartilage degeneration with improved activities of daily living. [2]
The treatment involves a course of 3 intra-articular infiltrations (Fig. 1) approximately 10-15 days apart. Or an infiltration of high-molecular-weight hyaluronic acid in single administration. Usually, one or more cortisone infiltrations are performed before the cycle or monoadministration to reduce inflammation of the joint and prepare it to better ‘accept’ the hyaluronic acid injection(s). The duration of the beneficial effect (reduction in pain and improvement in joint motility) lasts between 4 and 6 months, depending on the severity of the arthrosis.
Hyaluronic acid infiltrations, therefore, should not be understood as a cure for arthrosis, but as a conservative treatment that can slow down the progressive damage that this pathology can cause.[1] They can also be used after surgery performed arthroscopically to improve motility and reduce pain after surgery. [3] They can also be performed using an ultrasound-guided technique (Fig. 2).
In the case of advanced degeneration, infiltrations with PRP or (mesenchymal) stem cells are most indicated. If these do not work, prosthetic surgery can be used (see hip prosthesis, knee prosthesis, shoulder prosthesis).
Bibliography
- Altman R, Hackel J, Niazi F, Shaw P, Nicholls M (2018) Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Semin Arthritis Rheum 48:168–175.
- Legré-Boyer V (2015) Viscosupplementation: techniques, indications, results. Orthop Traumatol Surg Res 101:S101-108.
- Marcheggiani Muccioli GM, Wykes P, Hundle B, Grassi A, Roatti G, Funk L (2015) Effects of a synovial fluid substitute on early recovery after arthroscopic subacromial decompression of the shoulder. Musculoskelet Surg 99:121–126.
- Pereira H, Sousa DA, Cunha A, Andrade R, Espregueira-Mendes J, Oliveira JM, Reis RL (2018) Hyaluronic Acid. Adv Exp Med Biol 1059:137–153.
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