Viscosupplementation as an alternative to conventional treatment for the management of osteoarthritis of the knee

Medical treatment of osteoarthritis is challenging. Exercise, weight loss, physiotherapy, and analgesics are effective, but many patients with even moderate disease need more aggressive therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are problematical because they are a leading cause of gastrointestinal bleeding, which is associated with morbidity, mortality, and expense. Although often effective, surgical therapies, such as arthroscopy, debridement, and total knee arthroplasty, are invasive, costly, and not always suitable. Viscosupplementation is an effective treatment for OA that is well tolerated. Clinical trials have demonstrated that viscosupplementation with hylan G-F 20 is safer and more effective and than continuous NSAID therapy. In an open, retrospective analysis, hylan G-F 20 was effective in 77% and 87% of knees after first and second courses, respectively, with a rate per injection of 2.7% for local side effects. On the basis of clinical evidence and experience, a treatment algorithm is proposed in which viscosupplementation should be considered after simple analgesics and, in some patients, in place of other treatments ranging from over-the-counter NSAIDs to total knee replacement surgery.