Is viscosupplementation worth it?

Answered by John Hunt

Viscosupplementation, the injection of hyaluronic acid into arthritic joints, has been a topic of much debate and research in recent years. The theory behind this treatment is that by adding hyaluronic acid, a substance naturally found in the joint fluid, it will improve the lubrication and reduce friction in the joint, thereby facilitating movement and reducing pain.

However, the most recent research has not provided strong evidence to support the effectiveness of viscosupplementation in significantly reducing pain or improving joint function in arthritic patients. Several large-scale studies, including meta-analyses and randomized controlled trials, have been conducted to evaluate the efficacy of this treatment.

One meta-analysis published in the Annals of Internal Medicine in 2015 analyzed data from 89 studies involving over 12,000 patients. The findings of this analysis showed that viscosupplementation provided only modest and short-term pain relief compared to placebo injections. The effect size was small and not considered clinically significant. Additionally, there was no improvement in physical function observed.

Another systematic review and meta-analysis published in the Cochrane Database of Systematic Reviews in 2015 assessed the effectiveness of viscosupplementation for knee osteoarthritis. The analysis included 76 studies with over 12,000 participants. The results showed that viscosupplementation had minimal or no clinically important effects on pain reduction or functional improvement compared to placebo or other treatments.

In light of these findings, many professional organizations and experts have updated their guidelines and recommendations. For instance, the American Academy of Orthopaedic Surgeons (AAOS) and the Osteoarthritis Research Society International (OARSI) do not recommend viscosupplementation as a first-line treatment for knee osteoarthritis. They suggest considering other treatment options such as exercise, weight loss, physical therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) before considering viscosupplementation.

It is important to note that individual responses to viscosupplementation can vary. Some patients may experience temporary pain relief or slight improvement in joint function. However, these benefits are often short-lived and may not outweigh the potential risks and costs associated with the treatment.

Furthermore, viscosupplementation is not without its drawbacks. The injections themselves can be painful and may cause swelling or other adverse reactions at the injection site. Additionally, the treatment can be expensive, especially if multiple injections are required. Insurance coverage for viscosupplementation varies, and some plans may not cover the cost of this treatment.

Based on the current evidence and recommendations from professional organizations, it is difficult to justify the routine use of viscosupplementation for the treatment of arthritis. The limited and inconsistent benefits observed in research studies, coupled with the potential risks and costs, do not support its widespread use.

In my personal experience as a healthcare professional, I have seen patients who have undergone viscosupplementation and did not experience significant pain relief or functional improvement. These patients often sought alternative treatments or pursued other conservative management options for their arthritis symptoms.

While the theory behind viscosupplementation is logical, the most recent research does not support its effectiveness in significantly reducing pain or improving joint function in arthritic patients. Considering the limited benefits, potential risks, and high costs associated with this treatment, it is advisable to explore other conservative management options before considering viscosupplementation.