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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 16-10-2023 | Osteoarthrosis | KNEE

Impact of hyaluronic acid injection on the knee joint friction

Authors: Luisa de Roy, Kerstin Eichhorn, Martin Faschingbauer, Klaus Schlickenrieder, Anita Ignatius, Andreas Martin Seitz

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2023

Abstract

Purpose

The purpose of this in vitro study was to investigate whether or not hyaluronic acid supplementation improves knee joint friction during osteoarthritis progression under gait-like loading conditions.

Methods

Twelve human cadaveric knee joints were equally divided into mild and moderate osteoarthritic groups. After initial conservative preparation, a passive pendulum setup was used to test the whole joints under gait-like conditions before and after hyaluronic acid supplementation. The friction-related damping properties given by the coefficient of friction µ and the damping coefficient c (in kg m²/s) were calculated from the decaying flexion–extension motion of the knee. Subsequently, tibial and femoral cartilage and meniscus samples were extracted from the joints and tested in an established dynamic pin-on-plate tribometer using synthetic synovial fluid followed by synthetic synovial fluid supplemented with hyaluronic acid as lubricant. Friction was quantified by calculating the coefficient of friction.

Results

In the pendulum tests, the moderate OA group indicated significantly lower c₀ values (p < 0.05) under stance phase conditions and significantly lower µ₀ (p = 0.01) values under swing phase conditions. No degeneration-related statistical differences were found for µ_end or c_end. Friction was not significantly different (p > 0.05) with regard to mild and moderate osteoarthritis in the pin-on-plate tests. Additionally, hyaluronic acid did not affect friction in both, the pendulum (p > 0.05) and pin-on-plate friction tests (p > 0.05).

Conclusion

The results of this in vitro study suggested that the friction of cadaveric knee joint tissues does not increase with progressing degeneration. Moreover, hyaluronic acid viscosupplementation does not lead to an initial decrease in knee joint friction.

Gilat R, Haunschild ED, Knapik DM, Evuarherhe A Jr, Parvaresh KC, Cole BJ (2021) Hyaluronic acid and platelet-rich plasma for the management of knee osteoarthritis. Int Orthop 45(2):345–354PubMed

Caligaris M, Canal CE, Ahmad CS, Gardner TR, Ateshian GA (2009) Investigation of the frictional response of osteoarthritic human tibiofemoral joints and the potential beneficial tribological effect of healthy synovial fluid. Osteoarthr Cartil 17(10):1327–1332

Desrochers J, Amrein MW, Matyas JR (2013) Microscale surface friction of articular cartilage in early osteoarthritis. J Mech Behav Biomed Mater 25:11–22PubMed

Neu CP, Reddi AH, Komvopoulos K, Schmid TM, Di Cesare PE (2010) Increased friction coefficient and superficial zone protein expression in patients with advanced osteoarthritis. Arthritis Rheum 62(9):2680–2687PubMedPubMedCentral

Cooper C, Rannou F, Richette P, Bruyère O, Al-Daghri N, Altman RD, Brandi ML, Collaud Basset S, Herrero-Beaumont G, Migliore A, Pavelka K, Uebelhart D, Reginster JY (2017) Use of intraarticular hyaluronic acid in the management of knee osteoarthritis in clinical practice. Arthritis Care Res (Hoboken) 69(9):1287–1296PubMed

Petrella RJ, Cogliano A, Decaria J (2008) Combining two hyaluronic acids in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Clin Rheumatol 27(8):975–981PubMed

Nguyen C, Lefèvre-Colau M-M, Poiraudeau S, Rannou F (2016) Evidence and recommendations for use of intra-articular injections for knee osteoarthritis. Ann Phys Rehabil Med 59(3):184–189PubMed

Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M (2015) The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord 16:321PubMedPubMedCentral

Bonnevie ED, Galesso D, Secchieri C, Bonassar LJ (2019) Frictional characterization of injectable hyaluronic acids is more predictive of clinical outcomes than traditional rheological or viscoelastic characterization. PLoS ONE 14(5):e0216702PubMedPubMedCentral

10.

Chavda S, Rabbani SA, Wadhwa T (2022) Role and effectiveness of intra-articular injection of hyaluronic acid in the treatment of knee osteoarthritis: a systematic review. Cureus 14(4):e24503PubMedPubMedCentral

11.

Kawai N, Tanaka E, Takata T, Miyauchi M, Tanaka M, Todoh M, van Eijden T, Tanne K (2004) Influence of additive hyaluronic acid on the lubricating ability in the temporomandibular joint. J Biomed Mater Res A 70(1):149–153PubMed

12.

Kawano T, Miura H, Mawatari T, Moro-Oka T, Nakanishi Y, Higaki H, Iwamoto Y (2003) Mechanical effects of the intraarticular administration of high molecular weight hyaluronic acid plus phospholipid on synovial joint lubrication and prevention of articular cartilage degeneration in experimental osteoarthritis. Arthritis Rheum 48(7):1923–1929PubMed

13.

Mori S, Naito M, Moriyama S (2002) Highly viscous sodium hyaluronate and joint lubrication. Int Orthop 26(2):116–121PubMedPubMedCentral

14.

Bell CJ, Ingham E, Fisher J (2006) Influence of hyaluronic acid on the time-dependent friction response of articular cartilage under different conditions. Proc Inst Mech Eng H 220(1):23–31PubMed

15.

Corvelli M, Che B, Saeui C, Singh A, Elisseeff J (2015) Biodynamic performance of hyaluronic acid versus synovial fluid of the knee in osteoarthritis. Methods 84:90–98PubMedPubMedCentral

16.

Forsey RW, Fisher J, Thompson J, Stone MH, Bell C, Ingham E (2006) The effect of hyaluronic acid and phospholipid based lubricants on friction within a human cartilage damage model. Biomaterials 27(26):4581–4590PubMed

17.

Mederake M, Trappe D, Jacob C, Hofmann UK, Schüll D, Dalheimer P, Exner L, Walter C (2022) Influence of hyaluronic acid on intra-articular friction—a biomechanical study in whole animal joints. BMC Musculoskelet Disord 23(1):927PubMedPubMedCentral

18.

Martin-Alarcon L, Schmidt TA (2016) Rheological effects of macromolecular interactions in synovial fluid. Biorheology 53(2):49–67PubMed

19.

Warnecke D, Meßemer M, de Roy L, Stein S, Gentilini C, Walker R, Skaer N, Ignatius A, Dürselen L (2019) Articular cartilage and meniscus reveal higher friction in swing phase than in stance phase under dynamic gait conditions. Sci Rep 9(1):5785PubMedPubMedCentral

20.

Li Y, Yuan Z, Yang H, Zhong H, Peng W, Xie R (2021) Recent advances in understanding the role of cartilage lubrication in osteoarthritis. Molecules 26(20):6122PubMedPubMedCentral

21.

Kleemann RU, Krocker D, Cedraro A, Tuischer J, Duda GN (2005) Altered cartilage mechanics and histology in knee osteoarthritis: relation to clinical assessment (ICRS Grade). Osteoarthr Cartil 13(11):958–963

22.

de Roy L, Warnecke D, Hacker SP, Simon U, Dürselen L, Ignatius A, Seitz AM (2021) Meniscus injury and its surgical treatment does not increase initial whole knee joint friction. Front Bioeng Biotechnol 9:779946PubMedPubMedCentral

23.

Bonnefoy-Mazure A, Armand S (2015) Normal gait. 199–214

24.

ISO 14243-1 (2009) Implants for surgery–wear of total knee joint prostheses—part 1: loading and displacement parameters for wear-testing machines with load control and corresponding environmental conditions for test

25.

Shane Anderson A, Loeser RF (2010) Why is osteoarthritis an age-related disease? Best Pract Res Clin Rheumatol 24(1):15–26PubMedPubMedCentral

26.

Spahn G, Mückley T, Klinger HM, Hofmann GO (2008) Whole-organ arthroscopic knee score (WOAKS). BMC Musculoskelet Disord 9(1):155PubMedPubMedCentral

27.

Robert H, Lambotte JC, Flicoteaux R (2011) Arthroscopic measurement of cartilage lesions of the knee condyle: principles and experimental validation of a new method. Cartilage 2(3):237–245PubMedPubMedCentral

28.

Pauli C, Grogan SP, Patil S, Otsuki S, Hasegawa A, Koziol J, Lotz MK, D’Lima DD (2011) Macroscopic and histopathologic analysis of human knee menisci in aging and osteoarthritis. Osteoarthr Cartil 19(9):1132–1141

29.

Freeman MAR, Pinskerova V (2005) The movement of the normal tibio-femoral joint. J Biomech 38(2):197–208PubMed

30.

Stein S, Höse S, Warnecke D, Gentilini C, Skaer N, Walker R, Kessler O, Ignatius A, Dürselen L (2019) Meniscal replacement with a silk fibroin scaffold reduces contact stresses in the human knee. J Orthop Res 37(12):2583–2592PubMedPubMedCentral

31.

Radecki J, Kim S, Vad D (2009) Synvisc-One™ for the treatment of knee osteoarthritis. Int J Clin Rheumatol 4:631–639

32.

Crisco J, Blume J, Teeple E, Fleming B, Jay G (2007) Assuming exponential decay by incorporating viscous damping improves the prediction of the coeffcient of friction in pendulum tests of whole articular joints. Proc Inst Mech Eng H J Eng Med 221:325–333

33.

Warnecke D, Schild NB, Klose S, Joos H, Brenner RE, Kessler O, Skaer N, Walker R, Freutel M, Ignatius A, Dürselen L (2017) Friction properties of a new silk fibroin scaffold for meniscal replacement. Tribol Int 109:586–592PubMedPubMedCentral

34.

Bortel E, Charbonnier B, Heuberger R (2015) Development of a synthetic synovial fluid for tribological testing. Lubricants 3:664–686

35.

Heilmann HH, Lindenhayn K, Walther HU (1996) Das Synovia-Volumen gesunder und arthrotischer menschlicher Kniegelenke. Zeitschrift Fur Orthopadie Und Unfallchirurgie - Z ORTHOP UNFALLCHIR 134:144–148

36.

Ateshian GA (2009) The role of interstitial fluid pressurization in articular cartilage lubrication. J Biomech 42(9):1163–1176PubMedPubMedCentral

37.

Lin W, Klein J (2021) Recent progress in cartilage lubrication. Adv Mater 33(18):2005513

38.

Neu CP, Komvopoulos K, Reddi AH (2008) The interface of functional biotribology and regenerative medicine in synovial joints. Tissue Eng B Rev 14(3):235–247

39.

Murakami T, Yarimitsu S, Sakai N, Nakashima K, Yamaguchi T, Sawae Y (2017) Importance of adaptive multimode lubrication mechanism in natural synovial joints. Tribol Int 113:306–315

40.

Link JM, Salinas EY, Hu JC, Athanasiou KA (2020) The tribology of cartilage: Mechanisms, experimental techniques, and relevance to translational tissue engineering. Clin Biomech (Bristol, Avon) 79:104880PubMed

41.

Furmann D, Nečas D, Rebenda D, Čípek P, Vrbka M, Křupka I, Hartl M (2020) The effect of synovial fluid composition, speed and load on frictional behaviour of articular cartilage. Materials (Basel) 13(6):1334PubMed

42.

Lee SS, Duong CT, Park SH, Cho Y, Park S, Park S (2013) Frictional response of normal and osteoarthritic articular cartilage in human femoral head. Proc Inst Mech Eng H 227(2):129–137PubMed

43.

Peck J, Slovek A, Miro P, Vij N, Traube B, Lee C, Berger AA, Kassem H, Kaye AD, Sherman WF, Abd-Elsayed A (2021) A comprehensive review of viscosupplementation in osteoarthritis of the knee. Orthop Rev (Pavia) 13(2):25549PubMed

44.

Chatterjee A, Dubey DK, Sinha SK (2021) Effect of loading on the adhesion and frictional characteristics of top layer articular cartilage nanoscale contact: a molecular dynamics study. Langmuir 37(1):46–62PubMed

45.

Teeple E, Fleming BC, Mechrefe AP, Crisco JJ, Brady MF, Jay GD (2007) Frictional properties of Hartley guinea pig knees with and without proteolytic disruption of the articular surfaces. Osteoarthr Cartil 15(3):309–315

46.

Akelman MR, Teeple E, Machan JT, Crisco JJ, Jay GD, Fleming BC (2013) Pendulum mass affects the measurement of articular friction coefficient. J Biomech 46(3):615–618PubMed

47.

Mabuchi K, Obara T, Ikegami K, Yamaguchi T, Kanayama T (1999) Molecular weight independence of the effect of additive hyaluronic acid on the lubricating characteristics in synovial joints with experimental deterioration. Clin Biomech (Bristol, Avon) 14(5):352–356PubMed

48.

Obara T, Mabuchi K, Iso T, Yamaguchi T (1997) Increased friction of animal joints by experimental degeneration and recovery by addition of hyaluronic acid. Clin Biomech 12(4):246–252

49.

Bonnevie ED, Bonassar LJ (2020) A century of cartilage tribology research is informing lubrication therapies. J Biomech Eng 142(3):031004PubMed

50.

Rebenda D, Ranuša M, Čípek P, Toropitsyn E, Vrbka M (2023) In situ observation of hyaluronan molecular weight effectiveness within articular cartilage lubrication. Lubricants 11(1):12

51.

Balazs E (1982) The pysical properties of synovial fluid and the specific role of hyaluronic acid. In: Helfet AJ (ed) Disorders of the Knee. JB Lippincott, Philadelphia, pp 61–74

52.

Smith MM, Ghosh P (1987) The synthesis of hyaluronic acid by human synovial fibroblasts is influenced by the nature of the hyaluronate in the extracellular environment. Rheumatol Int 7(3):113–122PubMed

53.

Goto M, Hanyu T, Yoshio T, Matsuno H, Shimizu M, Murata N, Shiozawa S, Matsubara T, Yamana S, Matsuda T (2001) Intra-articular injection of hyaluronate (SI-6601D) improves joint pain and synovial fluid prostaglandin E2 levels in rheumatoid arthritis: a multicenter clinical trial. Clin Exp Rheumatol 19(4):377–383PubMed

54.

Wang M, Liu C, Thormann E, Dėdinaitė A (2013) Hyaluronan and phospholipid association in biolubrication. Biomacromol 14(12):4198–4206

55.

Kupratis ME, Gure AE, Benson JM, Ortved KF, Burris DL, Price C (2022) Comparative tribology II-measurable biphasic tissue properties have predictable impacts on cartilage rehydration and lubricity. Acta Biomater 138:375–389PubMed

56.

Wheaton AJ, Dodge GR, Elliott DM, Nicoll SB, Reddy R (2005) Quantification of cartilage biomechanical and biochemical properties via T1rho magnetic resonance imaging. Magn Reson Med 54(5):1087–1093PubMed

57.

Nieminen MT, Töyräs J, Laasanen MS, Silvennoinen J, Helminen HJ, Jurvelin JS (2004) Prediction of biomechanical properties of articular cartilage with quantitative magnetic resonance imaging. J Biomech 37(3):321–328PubMed

Title: Impact of hyaluronic acid injection on the knee joint friction
Authors: Luisa de Roy
Kerstin Eichhorn
Martin Faschingbauer
Klaus Schlickenrieder
Anita Ignatius
Andreas Martin Seitz
Publication date: 16-10-2023
Publisher: Springer Berlin Heidelberg
Keywords: Osteoarthrosis
Osteoarthrosis
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07602-w

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Springer Medicine

Impact of hyaluronic acid injection on the knee joint friction

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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