Supartz injection techniques

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  • This slide is micro-anatomy of cartilage.
    The cartilage are constructed by cartilage cells and cartilage matrix.
    The major component of cartilage matrix are meshed collargen, hyaluronic acid and proteoglycan.
    The hyaluronic acid and proteoglycan combine to core protein.
  • This slide is our theory of OA from our biochemical study and research.
    Age, Genetics and Gender are natural factors.
    Mechanical stress in daily life increased surface fibrillation and decreased lubrication in cartilage.
    Superoxide anion, Proteinkinase and Cytokinase are made in joint by nature aging.
    Synovitis are produced in daily life. These factores makes Cartilage degradation.
    Cartilage degradation makes Cartilage fragments.
    And this cartilage fragments are “eat by synovium” and “produce secondly synovitis”.
    So,“Cartilage degradation” and “Synovitis” are increased by themselves in circulation.
    This “Cartilage degradation and Synovitis circulation” is the stage of OA.
  • This slide is the effect of natural HA in joint
    Natural HA acts as combination matrix between many kinds of cells such as body fluid, skin, and other organs.
    Your wife knows well that facial cosmetic cream contains HA.
    In the joint cartilage, HA aggregates to proteoglycan and make to keep water.
    1 g of aglycan can keep 50 mL of water. It may cause the cartilage elasticity.
    In joint fluid, HA acts as lubricant and viscous fluid ,due to high molecular weight as like a motor machine oil, and exists in synovium, capsule, blood and lymph.
  • “Why do Japanese doctors use so much Supartz? “
    We have many reasons.
    Insurance system
    Doctor’s fee
    Patient’s fee (old patient is free charge to hospital)
    Long history to non-operative treatment to old joint over two thousand years, so old patient don’t want operation.
    Doctor’s choice:
    Don’t like to use steroids.
    Supartz is safe, clean, easy. “Open”, “Put needle”, “Injection” just 5 seconds.
    I have been experienced no side effect by Supartz.
    Pure and natural from rooster comb.
    Effects are comfortable and long-lasting, by Japanese taste.
    More attractive to patients than TKR to Japan doctors and patients
  • This slide is the mechanism of pain relief for Supartz.
    SEIKAGAKU CORPORATION, manufacturing company of Supartz and I have many studies and researches about this area but I have no time today. Maybe, Mr. Twardzik-san has many papers. Please ask him.
    The left side of slide is “Direct action of Supartz”, or BIOMECHANICALLY effect.
    It is easy to understand about viscosity.
    Supartz covers sensory nerve receptor of joint tissue by captures of analgestic mediator in synovial fluid due to it’s viscosity, structure of random coil, anionic charge.
    The right side of slide is “Indirect action of Supartz”, or BIOCHEMICALLY effect.
    “Prevents cartilage degeneration”, ”Improves pathological joint fluids”, “Improves lubricating function”, “Improves sensitivity to pain mediator” act to “Pain relief and improvement of daily activities”.
  • This slide is penetration effect of Supartz.
    All of you think that Supartz acts only surface of cartilage.
    But when Supartz penetrate into tissues, Supartz inhibits proteoglycan release in cartilage , and improves cartilage metabolism.
    Into synovial membrane, Supartz covers pain receptors in synovial membrane ,and suppresses pain.
  • To avoid infections, the utmost care is needed in giving an intraarticular injection. First, for disinfection, wipe the injection site thoroughly with cotton soaked in alcohol. Disinfect the area with an antiseptic solution such as Povidone Iodine outward from the center. Wait about one minute to help allow adequate disinfection. Then after the injection, wipe again with a cotton piece soaked in hypoethalaman.
    It is essential to assure thorough disinfection.
  • will demonstrate how to inject Supartz into the knee joint capsule by means of two roots: from the medial and lateral approach.
  • Injection from the lateral aspect is often performed when aspiration of joint effusion is needed. Joint effusion is present within the joint capsule in this patient, and thus, the joint effusion is aspirated before the injection of Supartz. Let the patient lie down with the extended knees. Then confirm the patella and the femur from the lateral aspect. The needle will be inserted into the gap between the two bones. When the gap is narrow, press down the medial side of the patella to widen the gap for easy injection. Disinfect the injection site and insert an empty syringe with 19 gauge needle horizontally for drainage of joint effusion. Keep inserting the needle carefully into the joint cavity between the patella and the femur. When Supartz is injected from the beginning, the needle is inserted in the same way.
    After the aspiration of joint effusion, change the injection syringes to Supartz while keeping the needle remaining where it is. The pressure on the syringe should be smooth and without a great deal ofresistance. You can finish by applying a sterilized gauze with tape.
  • Injection from the medial approach is easy and widely employed. It is particularly useful in cases where aspiration of joint effusion is unnecessary. The patient lies down on a bed with her knees bent at an angle of about 90 degrees. To identify the injection site, we palpate the medial condyle margin of the patella, the medial/femoral condyle, and the tibial articular margin. The needle will be inserted into the center of the triangular gap. Make sure to disinfect the injection site thoroughly. And prepare Supartz with a 22 or 23 gauge needle. Insert the needle straight from the front at an angle of about 30 degrees and about one or two centimeters then the needle penetrates the joint capsule. Take utmost care not to damage the intraarticular tissues. Exercise greatest care in inserting the needle straight until its tip touches the cartilage of femoral condyle and then pulling it back slightly. Now the needle is certainly placed inside the joint capsule. When Supartz is injected accurately, insertion into the joint capsule is confirmed with no sense of resistance. Disinfect again. Let the patient give flexion and extension of the knees several times so that Supartz spreads evenly over the whole joint cavity. Finally, let's cover the injection site with a piece of sterilized gauze and a band-aid.
  • Supartz injection techniques

    1. 1. Injection Technique for Joint Fluid Therapy A Conservative Treatment of Osteoarthritis
    2. 2. Agenda Overview of Osteoarthritis (OA) The Continuum of Care for OA The Role of Joint Fluid Therapy Intra-articular Injection Technique
    3. 3. The Knee
    4. 4. The Anatomy of the Knee
    5. 5. Cartilage lamina splendens superficial layer deep layer cortical bone cancellous bone 2mm
    6. 6. Cartilage Proteoglycan aggregate Chondrocyte Collagen fibril Hyaluronan
    7. 7. Cartilage Matrix
    8. 8. Osteoarthritis
    9. 9. Osteoarthritis of the Knee Age, Genetics, Gender Mechanical Stress Increased Surface Fibrillation and Decreased Lubrication Superoxide Anion Proteinase Cytokine Synovitis Cartilage degradation
    10. 10. Effects of Osteoarthritis Decreased molecular weight of HA Decreased concentration of HA Less physical protection from shock Less nerve protection Increased chemical breakdown of cartilage
    11. 11. OA Cycle of Degradation F a u lty S y n th e s is o r D e g ra da tio n o f H y alu ro n a n L o w e r V is co city o f th e In tr a c e llu la r M a trix A ccu m u la tio n o f C a ta b o lite s a n d D isru ptio n in C e ll M e ta bo lis m J o in t Im m o b ility S ta g n a tio n o f Tra n s sy n o via l Flo w
    12. 12. Late Stage OA
    13. 13. Treating OA
    14. 14. Recommendations for the Medical Management of Osteoarthritis of the Hip And Knee American College of Rheumatology Subcommittee on Osteoarthritis Arthritis & Rheumatism Vol. 43, 9 Sept. 2000, 1905-1915
    15. 15. Goals Control of Pain Improvement of Function Avoidance of toxic effects
    16. 16. Management Pathway 1. Non-Pharmacologic (NP) 2. Pharmacologic (P), in addition to maintained NP management. 3. Surgical, when pain is severely symptomatic and not responding to NP or P.
    17. 17. Non-Pharmacologic Patient education – Self management programs – Personalized social support via telephone – Weight loss – Exercise – Occupational Therapy – Joint Protection and Energy conservation
    18. 18. Non-Pharmacologic Physical Therapy – muscle strengthening exercises – Assistive devices for ambulation – Patellar taping – Wedged insoles – Bracing – Assistive devices for activities of daily living
    19. 19. Pharmacologic Oral Intra-articular Topical
    20. 20. Pharmacologic Oral – – – – Acetaminophen, up to 4g per day COX-2* NSAID plus Gastroprotectant* Nonacetylated salicylate* * After careful assessment of upper GI adverse event risk factors: Age, comorbidity, oral steroids, history of peptic ulcer and /or upper GI bleeding, anticoagulants
    21. 21. Pharmacologic Intra-articular – Steroids • Opioids, Glucocorticoids – Hyaluronan
    22. 22. Pharmacologic Topical – Capsaicin – Methylsalicylate
    23. 23. Surgical Lavage – Unproven Debridement Osteotomy Total Joint Arthroplasty
    24. 24. Treating OA With Joint Fluid Therapy
    25. 25. The Effect of Natural HA in the Joint Natural HA acts as combination matrix between many kinds of cells – Body fluid, skin, other organs Joint cartilage – Aggregate to proteoglycan - keeps water. – 1 g of aglycan can keep 50 mL of water = cartilage elasticity. Joint fluid – Lubricant and viscous fluid. – Exists in synovium and capsule. Natural HA – Density : 2.7 (old) to 4 (young) mg/mL density in normal joint fluid. – Decreased density and viscosity in the inflammatory joint.
    26. 26. Why use hyaluronan? Potential long term problems with steroids. Safe, clean, easy. Pure and natural. Effects are comfortable and long-lasting. More attractive to patients than TKR.
    27. 27. Pain Relief for Hyaluronan Direct Action Captures analgesic mediator in synovial fluid (viscosity, structure of random coil,anionic charge) Covers sensory nerve receptor of joint tissue Indirect Action Inhibits cartilage degeneration Improves lubricating function Improves pathological joint fluids Improves sensitivity to pain mediator Pain relief and improvement of daily activities
    28. 28. Action of Hyaluronan on Joint Tissue Hyaluronan PENETRATION Cartilage Inhibits proteoglycan release Improves cartilage metabolism Synovial Membrane Covers pain receptors Suppresses pain
    29. 29. The Effective Use of Sodium Hyaluronate Not a cure for OA. Slow-acting and long-lasting. Most effective for early and middle stage OA. – Very good conservative treatment plan for older patients with moderate OA! – The relief can be remarkable. Consider the young athlete.
    30. 30. Conclusion OA is an accelerating biochemical cycle causing cartilage degradation. There is no cure for OA. Sodium hyaluronate is a safe, effective, non-invasive treatment for mild to moderate stages of OA and patients of all ages.
    31. 31. Injection Technique
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