In the skin, eyes, umbilical cord, connective tissues, such as the synovial membranes of the joints. Hyaluronic acid is present in all these districts and when something is wrong – due to aging, wear and tear, surgery or trauma that can cause wounds – its integration from the outside can come to the rescue. However, the evidence of effectiveness does not always support its use in all these fields: for example, more than one doubt has been raised when talking about hyaluronic acid used in aesthetics, especially if used as a supplement. In other cases the use of hyaluronic acid is generally considered more effective. This is the case of orthopedics, where it is used above all for injections for the treatment of moderate or mild arthrosis, within a branch that takes the name of orthobiology and which includes minimally invasive treatments that aim to extinguish the inflammation, favoring the recovery of damaged tissues. When is it used and how? We talked about it with Simone Ripantisecretary of the Italian Society of Orthopedics and Traumatology (Siot), and medical director at the Orthopedics and Traumatology UOC of the S. Giovanni Addolorata Hospital (among the structures of excellence in the area of Orthopedics for the knee, shoulder and hip).
Anti-wrinkle supplements to drink: are they really effective? by Lisa Cesco November 14, 2021
Hyaluronic acid against arthrosis
“Hyaluronic acid infiltrations are carried out in cases of joints affected by arthrosis. Those most subject to this type of damage and wear are load-bearing arthrosis, such as the knee, hip and ankle, and they are also those in which hyaluronic acid infiltrations are preferably used”, explains Ripanti. Of all, the knee and hip are the most common, followed by the ankle and to a lesser extent the shoulder. “The principle behind using hyaluronic acid is that in arthritic joints there is wear of the articular cartilage, resulting in pain and swelling. It also reduces the amount of synovial fluid, a lubricant present in the synovial membrane rich in hyaluronic acid.” The infiltrations of hyaluronic acid – technically viscosupplementations – aim to increase the viscosity of the synovial fluid: “The effect is an increase in lubrication, which is also associated with a sort of filler, cushioning effect – Ripanti continues – the volume of the hyaluronic acid in fact it helps to reduce friction between the damaged parts, and creates a sort of protection for those that are not yet worn”. In fact, hyaluronic acid infiltrations are reserved only for cases of mild and moderate arthrosis.
Hyaluronic acid: not only a ‘filler’ to rejuvenate but also therapy by Giuseppe del Bello 16 October 2023
Which hyaluronic acid?
There are many types of hyaluronic acid on the market, with different molecular weights. The most used – explains the specialist – are those of medium and high weight. There are also different types, such as cross-linked ones (in which the hyaluronic acid molecules are connected to each other) and in the form of gel. The choice of the type to use depends on various factors, such as the degree of arthrosis, the type of joint, the age and level of activity of the patient: “For example, in athletes the form used is often that of gels, at a higher density, which for this very reason is not used for shoulder arthrosis”. The number of injections, then, depends in turn on the type of hyaluronic acid used: from one to three, with variable times between one injection and another, minimum of one week, continues the expert: “If necessary, two cycles a year can also be performed. In some cases, such as in knee osteoarthritis, it can be performed in any clinic, for others, such as in the hip, the infiltration must be ultrasound-guided”.
Orthopedic prostheses, in Italy 20 thousand “expiring” every year 07 March 2024
Do hyaluronic acid injections work?
Only monitoring patients over time allows us to measure the effectiveness of the treatment, which according to Ripanti reports is generally good. But, although treatment with hyaluronic acid is indicated for some treatments (including that of knee osteoarthritis, as reported by the indications of the American FDA and therecommendation of Italian experts), the data are not always in agreement.
Hip and knee prostheses, a model to increase the success of operations by Anna Lisa Bonfranceschi 14 March 2024 Some time ago, for example, an extensive revision on the subject had observed only small, non-significant improvements in pain in patients with knee osteoarthritis, although not completely excluding efficacy in selected patient populations. On the other hand, other studies recently confirm the effectiveness of intra-articular infiltrations. “What is certain is that the indication whether or not to do the infiltration can only come from the specialist, also regarding the product to be used. Furthermore, arthrosis is a condition that evolves over time, and therefore those who suffer from it and perhaps have already undergone hyaluronic acid injections, may worsen in the future – in the short, medium or long term”, concludes the expert. And when it happens, the specialist and patient can evaluate together how to proceed, possibly with other orthobiology techniques.