Over the past 30 years there’s been increasing interest in the use of bio similar substances.
These include of course platelet rich plasma and commercially available hyaluronic acid substitutes broadly known as visco supplementation.
The purpose of these latter sentences is to replace or augment existing production of lubricating fluid located in all joints.
The quantity of lubricating gel in the joints decreases with injury and with age causing a decreased mechanical efficiency of the joint.
Although the knee joint was originally used as the model for Visco supplementation replacement, it has gradually expanded into other joints including the hip joint.
Depending on the compound used a single or weekly series of injections are done.
After positioning on a fluoroscopic table, scout x-ray images are taken to locate the ideal entry point into the joint.
A sterile preparation and draping of the skin is carried out followed by a local anesthetic injected into the skin, with or without a topical freezing spray prior hand.
A 22gauge needle is carefully advanced into the joint and the needle tip position is confirmed by the use of an x-ray contrast agent.
It should be noted that when joint injections are done without the aid of a floor scope or ultrasound to confirm the location, up to 40% of the injections are determined to be outside of the joint.
Fluoroscopic guidance is the gold standard when combined with contrast highlighting to determine the accurate placement.
Once the needle tip position is satisfactorily confirmed, the Visco supplement is injected into the joint followed by a small quantity of a saline flush to clear the needle.
The procedure typically takes less than 20 minutes and the patient goes home with a small Band-Aid.
Ice and anti-inflammatory medication may be taken if there is any discomfort in the joint.
Depending on the product that is injected results are often noted after a few weeks.
This process can be repeated without any deleterious risks for the joints (unlike repeated)