Can Combining Hyaluronic Acid and Physiotherapy in Knee Osteoarthritis Improve the Physicochemical Properties of Synovial Fluid?

• Published in: Biomedicines Vol. 12; no. 2; p. 449
• Main Authors: Onu, Ilie, Gherghel, Robert, Nacu, Isabella, Cojocaru, Florina-Daniela, Verestiuc, Liliana, Matei, Daniela-Viorelia, Cascaval, Dan, Serban, Ionela Lacramioara, Iordan, Daniel Andrei, Tucaliuc, Alexandra, Galaction, Anca-Irina
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01-02-2024
• Subjects: Analysis; Arthritis; ATR-FTIR spectroscopy; B cells; bioadhesion; Cartilage; Contraindications; Cryotherapy; Exercise; Hyaluronic acid; Inflammation; Joint diseases; Lasers; Lipids; Lubricants & lubrication; Macromolecules; Mechanical properties; Osteoarthritis; Pain; Phospholipids; Physical fitness; Physical therapy; Physicochemical properties; Polysaccharides; Proteins; Quality of life; rheological properties; Rheumatology; Synovial fluid; Therapeutics, Physiological; Transcutaneous electrical nerve stimulation-TENS; Tumor necrosis factor-TNF; Ultrasonic imaging; Viscoelasticity; Germany; Romania; ATR-FTIR spectroscopy; knee osteoarthritis; rheological properties; synovial fluid; physical therapy; bioadhesion; hyaluronic acid
• ISSN: 2227-9059; 2227-9059
• DOI: 10.3390/biomedicines12020449

Known as the degenerative disease of the knee with the highest prevalence, knee osteoarthritis (KOA) is characterized by a gradual destructive mechanism that, in severe cases, can provoke the need for total knee substitution. As the disease progresses, various enzymatic, immunological, and inflammatory processes abnormally degrade hyaluronic acid (HA), SF's main component, and affect the concentrations of specific proteins, with the final results seriously endangering synovial fluid (SF)'s rheological and tribological features and characteristics. No effective treatments have been found to stop the progression of KOA, but the injection of HA-based viscoelastic gels has been considered (alone or combined with physiotherapy (PT)) as an alternative to symptomatic therapies. In order to evaluate the effect of viscosupplementation and PT on the characteristics of SF, SF aspirated from groups treated for KOA (HA Kombihylan
and groups that received Kombihylan
and complex PT) was analyzed and compared from analytical, spectrophotometrical, and rheological perspectives. In the patients treated with PT, the SF extracted 6 weeks after viscosupplementation had a superior elastic modulus (G') and viscous moduli (G″), as well as a homogeneous distribution of proteins and polysaccharides. The viscosupplementation fluid improved the bioadhesive properties of the SF, and the use of the viscosupplementation fluid in conjunction with PT was found to be favorable for the distribution of macromolecules and phospholipids, contributing to the lubrication process and the treatment of OA-affected joints.