Viscosupplementation

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Degenerative disease of the sacroiliac joint includes pregressive erosion of the articular cartilage and synovial inflammation. Further, there is loss of the viscoelastic properties of the synovial fluid, making the cartilage more susceptible to further mechanical damage (5,23,24). The loss of the viscoelasticity is felt to be the direct result of the loss of the protective effect of hyaluronan, a naturally occurring lubricating glycasaminoglycan found in synovial fluid (5,25-28).

Viscosupplementation of the sacroiliac joint with hylan has been recently reported (5), and can help achieve pro

Pictures Inflammed Sacroiliac Joint

Fig. 3. Plain film image illustrating the correct prearthrographic needle positioning of the 22-gauge spinal needle in the poster-oinferior quarter of the sacroiliac joint.

longed pain relief in patients with sacroiliac joint pain. Hylans are crosslinked hyaluronans, which produce an improvement in the rheological and viscoelastic properties while maintaining a longer retention time in the synovial space (5,26). Hylan can decrease the progression of osteoarthritis in some joints (5). The onset of significant relief occurs in less than 1 h, peaking within 4-5 d, and lasting up to 6-8 mo or longer. This treatment does not permanently resolve the pain. The hylan may serve to restore the rheological properties of the synovial fluid and the joint homeostasis, improving the fluid mechanics, allowing for improved joint motion, and decreasing the nociceptive responses of the inflammed joint (with its antibradykinin effects) (5,7,25,27).

Injected viscoelastic solutions have a 1- to 2-d intraarticular half-life (28), and therefore viscosupplementation injections must be repeated many times (5). Following needle placement within the sacroiliac joint as described in the preceding, 1 cc (8 mg) of Hylan GF-20 (Sinvisc) is injected. The hylan injections are repeated three times at 2-wk intervals.

As the effects of viscosupplementation persist well beyond the half-life within the joint space, it is felt that the temporary restoration of and improvement of the rheological and viscoelastic properties of the synovial fluid allow for restoration of articular metabolic homeostasis (5). This treatment may lead to a restoration of sacroiliac joint function.

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