Viscosupplementation is the injection of hyaluronic acid (another molecular building block of the cartilage scaffold) into a joint. It has been found to relieve inflammation and pain and preserve joint function. There are many products available on the market, often covered by extended health plans. These products are injected during a short office procedure which is no more painful than receiving an immunization or blood test. The effect of these injections may last up to six months at which time they can be repeated. Patients with moderate arthritis have obtained significant relief and attained increased function of the injected joints. The most common joint injected is the knee.
One of the products we have injected extensively at our sports clinic in Toronto is
Durolane We are very excited about such products because the ease of administration (only one injection), the low rate of side effects and the excellent functional results patients have obtained.
Viscosupplementation should be considered in anyone with mild to moderate osteoarthritis especially of the knee.
PRP or platelet rich plasma is a technique that involves drawing a small amount of a patient’s blood and then isolating platelet growth factors found in the blood by centrifuging the sample. The isolated growth factors are then injected into the affected arthritic joint. These growth factors are thought to stimulate cartilage cells to produce more cartilage.
PRP has been around for at least 30 years however only in the last 10 years have we seen substantial and consistent scientific evidence that PRP does make a difference in relieving pain and improving function in arthritic joints. Due to the mechanism of action, PRP is felt to help to restore the cartilage of an arthritic joint. There are several protocols used in PRP treatment of arthritic joints which depend on individual patient factors. These details are determined after an appropriate medical assessment.
At the Toronto Centre for Sports Medicine we use the Harvest Smart Prep system for our platelet rich plasma treatments providing one of the highest concentration of platelet growth factors in the resulting PRP distillate. In addition, we go one step further and make use of The Harvest Terumo Clear Prep system which further separates out white cells from the growth factors in the platelet rich plasma. White cells are thought to increase the chances of pain and inflammation after PRP injections into joints.
nStride APS or Autologous Protein Solution by Zimmer Biomet is a technique similar to PRP with the added process of removing any inflammatory factors from the blood and concentrating the anti-inflammatory factors to results lasting 1-3 years in arthritic joints.