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Rheologic Behavior of Osteoarthritic Synovial Fluid after Addition of Hyaluronic Acid: A Pilot Study

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Clinical Orthopaedics and Related Research®

Abstract

Viscosupplementation is a symptomatic treatment of osteoarthritis (OA) intended to restore rheologic homeostasis of the synovial fluid by injecting hyaluronic acid intraarticularly. Despite the long history of this therapy, little is known about its mechanisms of action and differences between commercial preparations. We investigated the rheologic behavior of OA synovial fluid with time, when stored at 4°C, before and after the addition of two hyaluronic acid commercial preparations (linear and cross-linked). Thirteen OA synovial fluids were stored at 4°C and assayed using steric exclusion chromatography, which allows hyaluronic acid to be separated from the remaining pool of proteins and its molecular weight and concentration to be determined without any pretreatment and calibration. The synovial fluid rheology also was studied in vitro, before and after addition of two viscosupplements, over 6 weeks. The non-Newtonian behavior of synovial fluid throughout followup appears to be the result of loose interactions between proteins and hyaluronic acid. When mixed with the linear hyaluronic acid, synovial fluid becomes less non-Newtonian whereas the non-Newtonian behavior was reinforced when mixed with the cross-linked hyaluronic acid. The rheology was nearly unchanged for all synovial fluids over 6 weeks. Our preliminary trial shows it is possible to study synovial fluid, stored at 4°C, over a long time and suggests the enzymatic degradation of hyaluronic acid is negligible under these experimental conditions.

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Authors and Affiliations

  1. Laboratoire d’exploration et de morphométrie articulaire, Centre hospitalier Lyon–Sud, Pierre-Bénite, France

    Pierre Mathieu MD

  2. Service de Rhumatologie, Centre hospitalier Lyon–Sud, Pierre-Bénite, France

    Thierry Conrozier MD & Eric Vignon MD

  3. Centre de Rhumatologie, Grenoble, France

    Yves Rozand MD

  4. Centre de Recherches sur les Macromolécules Végétales (CERMAV-CNRS), 38041, Grenoble Cedex 9, France

    Marguerite Rinaudo PhD

Authors
  1. Pierre Mathieu MD
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  2. Thierry Conrozier MD
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  3. Eric Vignon MD
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  4. Yves Rozand MD
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  5. Marguerite Rinaudo PhD
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Correspondence to Marguerite Rinaudo PhD.

Additional information

One of the authors (TC) previously received payments from Genzyme Orthopaedics Laboratory, Cambridge, MA, for studies other than the current one and as an occasional consultant.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Centre de Recherches sur les Macromolécules Végétales (CERMAV-CNRS).

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Mathieu, P., Conrozier, T., Vignon, E. et al. Rheologic Behavior of Osteoarthritic Synovial Fluid after Addition of Hyaluronic Acid: A Pilot Study. Clin Orthop Relat Res 467, 3002–3009 (2009). https://doi.org/10.1007/s11999-009-0867-x

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  • DOI: https://doi.org/10.1007/s11999-009-0867-x

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