Knee osteoarthritis: disease burden, available treatments, and emerging options.

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Abstract

Conflict of interest statement: M.L. has served as a consultant for Pacira BioSciences, Inc., and receives royalties from Orthodevelopment. V.D. has served as a consultant or speaker for, received research support from, and/or has stock in Bioventus (specifically regarding DUROLANE), Emovi, Ferring, Goldfinch Consulting, Grand Care, J. Robert Gladden Orthopaedic Society, Medi Post, MEND, Motive, My Medical Images, Pacira BioSciences, Inc. (specifically regarding EXPAREL, iovera°, and ZILRETTA), Sanofi (specifically regarding SYNVISC), SIGHT Medical, STRIVE MedTech, the Journal of Orthopaedic Experience & Innovation, the National Institutes of Health, the Orthopaedic Research and Education Foundation, and Vertex. A.I.S. has served as a consultant, speaker, and/or researcher for DePuy, Pacira BioSciences, Inc. (specifically regarding ZILRETTA), and TraumaCad (Brainlab). 6. Orthop Rev (Pavia). 2021 Jul 10;13(2):25549. doi: 10.52965/001c.25549. eCollection 2021. A Comprehensive Review of Viscosupplementation in Osteoarthritis of the Knee. Peck J(1), Slovek A(2), Miro P(3), Vij N(3), Traube B(3), Lee C(4), Berger AA(5), Kassem H(1), Kaye AD(6), Sherman WF(7), Abd-Elsayed A(8). Author information: (1)Mount Sinai Medical Center, Miami Beach, FL. (2)Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix. (3)University of Arizona College of Medicine-Phoenix, AZ. (4)Creighton University School of Medicine-Phoenix Regional Campus, Phoenix, AZ. (5)Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. (6)Louisiana State University Shreveport, LA. (7)Tulane University, New Orleans, LA. (8)University of Wisconsin School of Medicine and Public Health, Madison, WI. PURPOSE OF REVIEW: The purpose of this systematic review is to discuss emerging evidence in the field of viscosupplementation for chronic knee pain secondary to Osteoarthritis (OA). This review focuses on types of viscosupplementation that are clinically available currently, evidence to support their use, contraindications, and adverse events. RECENT FINDINGS: OA, also known as degenerative joint disease, is the most common form of arthritis in the United States, affecting 54.4 million, or 22.7% of the adult population. The knee is the most common joint affected in OA, with up to 41% involvement, 30% in the hands, and 19% in the hips. The pathophysiology of OA is complex, with contributing factors including mechanical stress to the joint, as well as many person-specific factors such as genetic susceptibility, ethnicity, nutrition, and sex. Treatment modalities include weight control, exercise, non-steroidal and steroidal anti-inflammatory drugs, opioids, intra-articular platelet-rich plasma, placebo, corticosteroid injection, intra-articular viscosupplementation, and surgery. Viscosupplementation consists of injection of hyaluronic acid (HA) into affected joints, intending to restore the physiologic viscoelasticity in the synovial fluid (SF) in the absence of inflammation. HA has also been shown to downregulate pro-inflammatory factors, such as PGE2 and NFkB, and proteases and proteinases known to break down the joint matrix.The contraindications for HA injection are similar to any other injection therapy, and adverse events are usually mild, local, and transient. Viscosupplementation (VS) is effective over placebo and more effective than NSAIDs and corticosteroids in pain reduction and improved functionality; however, guidelines recommend neither for nor against its use, demonstrating variability in the existing evidence base.Current VS options divide primarily into native vs. cross-linked and low-molecular-weight vs. high-molecular-weight. Current treatment options include Hylan g-f-20, Sodium Hyaluronate preparations (Suparts Fx, Euflexxa, Gelsyn-3, Durolane, Hyalgen), single-use agents (Gel-One, Synvisc-One, Monovisc), and Hyaluronan (Orthovisc, Monovisc, Hymovic). They share a common safety profile, and all have evidence supporting their efficacy. Their specific details are reviewed here. SUMMARY: OA is the most common form of arthritis. It is a chronic, debilitating illness with a high impact on the functionality and quality of life of a significant part of the population in the western world. Treatments include medical management, physical therapy, activity modification, injection, and surgery. VS effectively reduces pain, increases functionality, and delays surgery in the knee to treat osteoarthritis. While previous studies have demonstrated variable results, more evidence is becoming available generally supportive of the benefit of VS in the treatment of knee OA. DOI: 10.52965/001c.25549 PMCID: PMC8567800