Viscoseal
Synovial Fluid Replacement
following Arthroscopic Surgery
Arthroscopic
Surgery confers significant benefits on thousands of
patients every year. The technique offers less insult to the joint,
decreases the risk of complication and infection, and reduces pain,
hospitalisation time, and recovery time.
As with any surgical intervention there can be side effects
associated with arthroscopy, primarily these are pain, swelling and
loss of joint mobility. A contribution to these effects is made by
the irrigation solutions used during arthroscopies to flush debris
from the joint, and maintain a clear visual aspect for the surgeon.
Because the irrigation solution washes out the synovial fluid (SF)
that resides in all synovial joints, the protective and lubricating
functions of the SF are temporarily absent, and several days may
elapse before the joint begins to replace the fluid that has been
lost (Fig. 1).
Additional problems arise due to the fact that irrigation solutions
may have a negative effect on the metabolism of articular cartilage
(1-3), and reduced mobility due to arthroscopy may lead to decreased
production of
Hyaluronan, a vital constituent of both cartilage and
synovial fluid (4-6).
Fig. 1: Irrigation fluid washes out
synovial fluid (blue) during arthroscopy.
Viscoseal (TRB Chemedica) is a 0.5% concentration, isotonic
solution of Hyaluronan of fermentative origin designed as a synovial
fluid substitute for use following arthroscopic surgery or joint
lavage.
Instilled into the joint immediately after surgery, Viscoseal acts
as a temporary substitute for the synovial fluid (SF) that has been
lost during arthroscopy, performing the lubricating, shock absorbing
and filtering functions of this fluid. In addition, it displaces any
irrigating solution left in the joint space, preventing impairment
of cartilage metabolism.
The introduction of Viscoseal into the joint space re-establishes
the protective coating of Hyaluronan over the surface of the
articular cartilage and synovial membrane. By replacing the
superficial layer of viscous Hyaluronan on the intima of the
synovium, potential innervation of pain receptors is reduced. This
reduction in pain helps to enhance joint mobility, which in turn
promotes the production of endogenous Hyaluronan.
Fig. 2: Viscoseal installation at the end
of the arthroscopic procedure
Clinical studies have shown that instilling exogenous Hyaluronan:
. Is effective, in combination with arthroscopic surgery, in
reducing pain and improving joint mobility in patients with chronic
joint derangement (7).
. Reduces pain, improves joint function and decreases levels of
prostaglandins and cytokines in the synovial fluid in patients with
chronic joint derangement (8,9).
In addition, research has demonstrated that exogenous Hyaluronan:
. Stimulates collagen remodelling and inhibits swelling of the
meniscus during healing of meniscal tears (10).
. Restores cartilage metabolism that has been disturbed by
irrigation with saline solution (11).
. Reduces joint pain caused by pain mediators (12-14).
Viscoseal & Shoulder Arthroscopy: A recent study by L Funk & P Wykes has demonstrated a
significant reduction in post-operative pain when Viscoseal is used
after shoulder arthroscopy.
Patients also needed less pain-killers and were able to go home
earlier from hospital after the operation. There were no adverse
effects.
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REFERENCES.
1. Reagan, BF et al. J. Bone Joint Surg. Am. 1983;65:629-31
2. Straehley, D et al. Trans. Orthop. Res. Soc. 1985; 10:260
3. Bulstra, SK et al. J. Bone Joint Surg. Br. 1994;76:468-70
4. Akeson, WH et al. Clin. Orthop. 1987; 219: 28-37
5. Saamanen, AM et al. J. Orthop. Res. 1990; 8: 863-73
6. Pitsillides, AA et al. Rheumatology. 1999; 38: 1108-12
7. Miyamoto, H et al. Aust. Dent. J. 1998; 43; 301-4
8. Hirota, W. Br. J. Oral Maxillofac. Surg. 1998; 36: 35-8
9. Sato, S et al. Oral Surg Oral Med Pathol Oral Radiol Endod. 1997;
84:241-4
10. Sonoda, M et al. Am. J. Sports Med. 2000; 28: 90-7
11. Bulstra, SK et al. Presentation at the 45th Annual Meeting of
the Orthopaedic Research Society, Anaheim, USA, Feb 1-4 1999.
12. Gotoh, S et al Nippon Yakurigaku Zasshi 1988; 92: 17-27
13. Gotoh, S et al Ann. Rheum. Dis. 1993; 52: 817-22
14. Yamashita, I et al. Nippon Seikeigaka Gakkai Zasshi 1995; 69:
735-43
