Infiltration with intraarticular hyaluronic acid
What is hyaluronic acid?
Hyaluronic acid (glycosaminoglycan sintético) is a natural part of synovial fluid in the joints and acts as a lubricant and a protective effect against the load on the joint. Thus aid, for example in the knee menisci and ligaments to perform its function.
In which cases is indicated use?
It is designed as intraarticular injection in the symptomatic treatment of mild to moderate osteoarthritis of the knee and hip. Also, in the European Union has approved its use for symptomatic treatment of pain associated with mild to moderate osteoarthritis in the ankle, shoulder, elbow, Doll, the fingers and toes and the temporomandibular joints and the facet of the column. It can also be used after an arthroscopy to improve postoperative pain and maintain joint protected.
What is an intra-articular infiltration?
It involves inserting into the joint, via injection, of a substance with beneficial effects for the pathology that joint. We use stabilized hyaluronic acid (3 ml for large joints and 1- 2 ml for moderate or small joints). This allows a single infiltration with the improvement in the symptoms can last from 6 and 8 months, unlike other treatment regimens that require three to five injections in a shorter period of time.
In order to prevent infections performed in strict aseptic conditions: sterile gloves, assistant to provide utensils, Wash skin with alcohol or antiseptic solution or other. Should not be injected if the joint or skin are very inflamed or infected. Should not be injected if skin wounds in the area of injection.
Only be injected into the joint. Do not inject intravascularly, we extraarticular, or injected into the tissue or in the synovium.
In joints such as the hip or the facet joints of the spine infiltration should be guided by imaging techniques: escopia, the arthroscopic ultrasound, so it is preferably performed in the operating room.
What risks are?
Intra-articular injection of hyaluronic acid can cause local reactions such as redness, pruritus, edema and pain. These reactions are usually very weak or nonexistent, but more often a feeling of distension of the joint that can cause some discomfort the first few days.
Precautions
Use cautiously in patients with venous or lymphatic stasis in the leg. It has not been tested in pregnant women or nursing mothers or children. It should not be injected if the patient is allergic to products containing hyaluronic acid. Use cautiously in patients suffering chondrocalcinosis because the product could trigger an exacerbation of the disease.
In case of joint effusion should be drained prior to infiltration.
Adverse Events
Most adverse reactions reported in clinical studies of hip and knee pain were described as, localized transient swelling or stiffness in the joint. Were mild to moderate and only occasionally require treatment with analgesics or NSAIDs (NSAIDs).
Overview of management
It should only be injected by authorized medical personnel familiar with the techniques of intraarticular injection of the synovial joint to be treated. The technique should be performed in appropriate facilities for intra-articular injections. In some synovial joints intra-articular injection should be guided by imaging techniques in order to deposit the product in the right place and prevent damage to adjacent vital joints.
Needle size is recommended 18 a 22 G, with an appropriate length. The use of smaller needles increases the pressure required to deliver the product.
What to do after an infiltration of hyaluronic acid?
The purpose of this technique is viscosupplementation of synovial fluid to pain relief and reduction of the inflammatory phenomena, thus being able to improve the patient's functional capacity.
After injection must be kept standing for 24 – 48 hours.