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Visco supplementation


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  • 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. 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. 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. 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. 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. Limitations of OA Treatment Options
  • 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. 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. 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. Viscosupplementation Is Recommended Therapy for Appropriate Patients  Viscosupplementation is an accepted treatment option • American College of Rheumatology1 • EULAR2 • OARSI3 • American Pain Society4
  • 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 Physical Properties of Synovial Fluid PhyPhysical Properties of Synovial Fluid sical Properties of Synovial FluidPhysical Properties of Synovial Fluid
  • 14. 14 What to expect from Hylan GF -20 Treatment ? Treatment ?
  • 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. 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. 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.  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. ® (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. (Hylan G-F 20) Administration
  • 21. (Hylan G-F 20) Administration
  • 22. (Hylan G-F 20) Administration  (Hylan G-F 20) Administration
  • 23. (Hylan G-F 20) Administration Superolateral approach
  • 24. (Hylan G-F 20) Administration  (Hylan G-F 20) Administration
  • 25. (Hylan G-F 20) Administration  (Hylan G-F 20) Administration
  • 26. (Hylan G-F 20) Administration  (Hylan G-F 20) Administration
  • 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. 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