Canada Viscosupplementation: Viscosupplementation In Canada Treatment Options For Osteoarthritis Of The Knee

Viscosupplementation, also known as hyaluronic acid injection therapy, is a non-surgical treatment option for knee osteoarthritis. It involves injecting a gel-like substance called hyaluronic acid (HA) into the knee joint space. HA occurs naturally in synovial fluid and acts as a lubricant and shock absorber in the joint. In osteoarthritic knees, the natural concentration of HA is reduced. Viscosupplementation aims to restore the viscoelastic properties of joint fluid by supplementing the decreased levels of HA.

How Does Canada Viscosupplementation Work?

HA has unique viscoelastic properties that allow it to absorb shock and lubricate the joint. During movement, HA attracts and retains water, maintaining pressure within the joint and cartilage cushioning. In osteoarthritis, disruption of HA leads to thinning of synovial fluid and less efficient joint lubrication. Viscosupplementation injections introduce exogenous HA into the joint space, increasing the viscosity and elasticity of synovial fluid. The gel-like substance absorbs shock, reduces friction between bones, and protects cartilage from further damage. Multiple injections over weeks provide sustained relief of pain and improved mobility.

Products Available In Canada

Thee are several HA injection products approved for use in Canada by Health Canada.

– Synvisc-One: A single-injection product containing high molecular weight hyaluronan. It provides relief for up to 6 months with one injection.

– Synvisc: A three-injection regimen containing hylan G-F 20 given once a week for 3 weeks. Each injection lasts approximately 3 months.

– Hyalgan/Supartz/Orthovisc: These contain lower molecular weight HA and are given as a 5 injection series over 3-5 weeks. Relief typically lasts 4-6 months.

– Euflexxa: A three-injection series containing 1% sodium hyaluronate given once a week. May provide benefits for up to 6 months.

– Gel-One/Gel-Syn: Single injection products containing cross-linked hyaluronan. Effects may last 6 months or longer.

– Durolane: A single injection of high molecular weight hyaluronic acid. Can provide pain relief for 6 months.

How Is It Administered?

Viscosupplementation is performed in a physician’s office or clinic as an outpatient procedure. The knee area is cleaned and numbing medication is applied to the skin and joint space. Using ultrasound or X-ray guidance, a small needle is inserted into the knee joint. The HA product is then injected into the space between the femur and tibia bones. Patients can resume normal activity right after but are advised to avoid strenuous exercise for 48 hours. A series of injections may be scheduled 2-3 weeks apart depending on the product.

 

Effectiveness And Duration Of Relief

High quality clinical research shows viscosupplementation provides significant pain relief and functional improvement in osteoarthritic knees. Studies comparing HA injections to placebo, exercise therapy or steroid injections consistently show benefits lasting 3-6 months. According to meta-analyses, over 70% of patients experience reduced pain and 50% display improved mobility from treatment. Single injection viscosupplements may provide lasting relief for 6 months or longer compared to 3 months from multi-dose therapies. Success rates are higher in patients with mild to moderate osteoarthritis compared to severe stages. Viscosupplementation is seen as a preferred alternative to surgery in early osteoarthritis.

Safety And Side Effects

HA injections have an excellent safety profile. Minor side effects like brief pain, swelling or soreness at the injection site occur in less than 5% of patients. Serious adverse events are extremely rare. As it contains naturally occurring HA molecules, there is minimal risk of allergic reaction. The procedure is not associated with infections when performed under sterile conditions. While not disease-modifying, viscosupplementation remains a safe non-surgical option for reducing osteoarthritis symptoms and delaying total joint replacement surgery.

Who Can Benefit From It?

Patients who may be considered for viscosupplementation include:

– Those with mild to moderate radiographic knee osteoarthritis not responding to conservative measures like physiotherapy, braces, weight loss.

– Older adults (over 50-60 years) with activity-related knee pain causing functional limitations.

– Younger, active individuals whose work or exercise involves repetitive knee movements.

– Patients who want to delay or avoid knee surgery for as long as possible.

– Those who have failed steroid injections or are not candidates for surgery due to other medical conditions.

Viscosupplementation is not recommended for severe end-stage osteoarthritis requiring joint replacement or inflammatory arthropathies like rheumatoid arthritis. However, it provides a cost-effective treatment option for many Canadians dealing with knee osteoarthritis.

As the population ages, rates of osteoarthritis are rising in Canada along with the need for effective non-surgical therapies. By restoring the natural protective properties of synovial fluid, viscosupplementation safely reduces pain from knee osteoarthritis and improves physical function. Numerous clinical trials and meta-analyses support its use as a first-line injection treatment. With several Health Canada-approved products available, viscosupplementation offers Canadian patients a proven non-operative approach to managing their knee osteoarthritis symptoms. When combined with exercise and weight management, it can delay joint replacement surgery and help maintain mobility.