Visco supplementation


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Visco supplementation

  2. 2. OSTEOARTHRITIS: What is It?  Degeneration  Loss or damage of cartilage  Distorted mechanics, grinding  Bone cyst and scar formation • Abnormal compensatory response – New bone formation – bone spurs – Inflammation (occasionally) – fluid, swelling, redness Managing Osteoarthritis in Primary Care By Gillian Hosie, John Dickson pg 11, 2000. Blackwell publication.
  3. 3. Diagnosing OA of the Knee: Identification Through Imaging • Kellgren-Lawrence radiographic criteria for assessment 1 • Order weight-bearing X-rays to reveal different views – Reveals compression of the knee – Reveals joint space narrowing – Provides a clear frontal view to help rule out patellofemoral syndrome CLASSIFICATION Normal Doubtful Mild Moderate Severe DESCRIPTION No features of OA Minute osteophyte; doubtful significance Definite osteophyte; normal joint space Moderate joint space reduction Joint space greatly reduced; subchondral sclerosis
  4. 4. INCIDENCE IN INDIA  In India, Osteoarthritis is most frequent joint disease with prevalence of 22% to 39% in India. 1  Demographic analysis revealed:  Most affected were females (63.1%).  Maximum patients were in the age group of 40-60 years (59.5%).  Most of the patients had osteoarthritis of the back (50%) followed by knee (45.23%) and hips (14.3%).2
  5. 5. Osteoarthritis joints contain synovial fluid that has become less viscous and less concentrated has a low molecular weight. Thus it offers less shock absorption, lubrication and protection of joints.
  6. 6. The Arthritis Treatment “Pyramid” Surgery Over-the-counter / Prescription NSAIDs, Opioids Paracetamol (acetaminophen) Patient education Physical and occupational therapy Weight reduction, exercise, assistive devices Creamer P et al. Lancet.1997;350:503-509. Intra-articular steroids / Viscosupplement
  7. 7. Limitations of OA Treatment Options
  8. 8. Treatment options Multiple treatment options are available VIZ. NSAIDS, Intra articular injections, physiotherapy and surgery. Intraarticular hyaluronic acid has been tried is several patients with mild to moderate osteoarthritis with
  9. 9. Visco supplimention Use of hyaluronic Acid  Synovial fluid contain hyaluronic acid, a polysac charide containing glucosamine and glucuronicacid.  The action of HA seems to inhibit inflammatory mediators, decreases cartilage degradation and promote cartitage matrix synthesis, it also decreases perception of pain.
  10. 10. Viscosupplementation Removal of pathologic synovial fluid Replacement with products with properties similar to normal joint fluid Objective :  Supplement elasticity and viscosity thus restoring a protective elastoviscous environment  Provide Lubrication and increased mechanical protection  Reduce pain and improve mobility
  11. 11. Viscosupplementation Is Recommended Therapy for Appropriate Patients  Viscosupplementation is an accepted treatment option • American College of Rheumatology1 • EULAR2 • OARSI3 • American Pain Society4
  12. 12. 12 Derivation of Hylan G-F 20  Cross-linked sodium hyaluronate has been shown to have longer residence time in the animal knee joint than unmodified sodium hyaluronate1-4  Unique cross-linked structure of hylan G-F 20 mirrors properties of healthy synovial fluid 1,2,5,6
  13. 13. 13 Physical Properties of Synovial Fluid PhyPhysical Properties of Synovial Fluid sical Properties of Synovial FluidPhysical Properties of Synovial Fluid
  14. 14. 14 What to expect from Hylan GF -20 Treatment ? Treatment ?
  15. 15. 15 The Science Behind Hylan G-F 20 How might Hylan G-F 20 preserve joint structure? • Reduction of matrix metalloprotease activity3 • Preservation of cartilage morphology4,5 • Direct beneficial effect on chondrocytes6 • Scavenging effect of reactive oxygen species7
  16. 16. Hylan G-F 20 at a Glance Elastoviscosity similar to the synovial fluid of healthy 18- to 27- year-olds Designed to meet the ideal standards of a synovial prosthetic device1 Biologically compatible Improved rheologic properties compared with synovial fluid of osteoarthritic joints Extended intra-articular residence time A series of 3 injections can provide a significant magnitude of pain relief for up to 12 months,2-4 which may improve function* A single injection of 6 mL has demonstrated a significant pain relief over 6 months5 Good tolerability profile in clinical trials and in practice
  17. 17. Hylan. GF 20  The higher molecular weight, more elastoviscous hyalan, GF 20 had significantly greater pain releiving effects than low molecular weight, less elastoviscious hyaluronan.
  18. 18.  Because of its visco elastic quality it may replace synovial fluid  Visco supplementation will have a slower onset of action than intra articular steroids, but the effect seems to last longer.  It has over 80% responder rate at one year.
  19. 19. ® (Hylan G-F 20) Administration  Mark the location for the injection  Common approaches for injecting the knee include1,2  Anterolateral (flexed knee)  Anteromedial (flexed knee)  Superolateral/lateral suprapatellar (straight knee)  Superomedial/medial suprapatellar (straight knee)  Lateral mid-patellar  Medial mid-patellar
  20. 20. (Hylan G-F 20) Administration
  21. 21. (Hylan G-F 20) Administration
  22. 22. (Hylan G-F 20) Administration  (Hylan G-F 20) Administration
  23. 23. (Hylan G-F 20) Administration Superolateral approach
  24. 24. (Hylan G-F 20) Administration  (Hylan G-F 20) Administration
  25. 25. (Hylan G-F 20) Administration  (Hylan G-F 20) Administration
  26. 26. (Hylan G-F 20) Administration  (Hylan G-F 20) Administration
  27. 27. (Hylan G-F 20) Administration Set Patient Expectations and Post-Procedure Education  Avoid any significant activity for next 24 to 48 hours  Minimal swelling and discomfort can be treated with over-the-counter pain medications, ice  Call office with any significant increase in pain or swelling
  28. 28. Post-Injection Care: Setting Patient Expectations and Managing Side Effects  Patient should avoid strenuous activity for 24 to 48 hours after injection  Explain that mild pain or swelling at the injection site is normal  If mild pain/swelling occurs, recommend ice, NSAID, rest and elevation1  If significant swelling occurs: Joint Aspiration  Send aspirate to lab to rule out joint infection  Crystal analysis  May provide intra-articular cortisone injection to decrease pain and inflammation  When pain returns, patients should be instructed to talk to their