Viscosupplementation with hyaluronic acid in the treatment for cartilage lesions: a review of current evidence and future directions

Abstract

Diseases involving the articular cartilage are one of the leading causes of physical impairment among the adult population. While surgical technique and advancement have allowed us effective means at treating these diseases, this is not without significant risk and morbidity. With a very solid safety profile, viscosupplementation with hyaluronic acid (HA) derivatives has become an excellent modality for treating diseased articular cartilage. Recent literature supports the use of HA not only in the management of the pain associated with osteoarthritis but also as a disease-modifying agent as well. Further studies have started to define exciting new roles for viscosupplementation in the treatment for acute injuries to the joint microenvironment.

A Patient with Fatal Necrotizing Fasciitis following the Use of Intra-Articular Sodium Hyaluronate Injections: A Case Report

“…However, there are no previously described cases of necrotizing fasciitis following viscosupplementation. As mentioned earlier, sodium hyaluronate injections have proven to be quite safe and have a low incidence of serious side effects [1, 4, 6–11]. The overall incidence of side effects is approximately 1–3% per injection [20].…”

“…In general, the literature has shown an excellent safety profile for this treatment modality, with the most common adverse events being mild injection site pain and swelling [1, 4, 6–11]. In this report, we describe a case of a woman who had received a total of 30 sodium hyaluronate injections over the course of 5 years and developed severe necrotizing fasciitis near the injection site.…”

“…An osteoarthritic knee has up to 50% less hyaluronan and the molecule itself is degraded, reducing its molecular weight. This causes increase in coefficient of friction and difficulty with joint movement [4]. Hyalgan (Fidia, S.p.A., Abano Terme, Italy) is a sodium hyaluronate intra-articular injectable medication, derived from rooster combs, having identical viscoelastic properties as human hyaluronic acid [5].…”

A Fatal Sepsis Caused by Hyaluronate Knee Injection: How Much the Medical History and the Informed Consent Might Be Important?

“…In general, an excellent safety profile for this treatment method has been widely shown, with few common adverse events, such as mild injection site pain and swelling [12–16]. However, there are several adverse effects that may occur in either poor injection technique or patients with preexisting morbidities [17, 18].…”

Use of firocoxib for the treatment of equine osteoarthritis

“…4 OA disease-modifying therapies commonly used in the horse include hyaluronic acid, triamcinolone acetonide (corticosteroids), interleukin (IL)-1 receptor-antagonist protein, polysulfated glycosaminoglycans (GAGs), diclofenac, avocado and soybean unsaponifiable extracts, and surgical intervention. [5][6][7][8][9][10][11] Common symptom-modifying therapies include corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and potentially hyaluronic acid. 6,10,[12][13][14][15] NSAIDs inhibit components of the enzyme system that converts arachidonic acid into prostaglandins (PGs) and thromboxanes ( Figure 1).…”