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The Bristol Knee Clinic

The Bristol Orthopaedic Clinic

• The Glen Spire Hospital, Bristol
• St Mary's Hospital, Bristol
• St Joseph's Hospital, Newport
• The Lister Hospital, London

Appointment Bookings:

• Tel: 0117 970 6655


The "Glen" Spire Hospital
Redland Hill
Bristol BS6 6UT

Tel: 0117 980 4080

Bristol Nuffield Hospital at St Mary's
Upper Byron Place
Bristol BS8 1JU

Tel: 0117 970 6655

St Joseph's Hospital
Harding Avenue
Newport NP20 6ZE

Tel: 01633 820300

The Lister Hospital
The Lister Hospital
Chelsea Bridge Rd.

Tel: 01179 706655

Viscosupplementation for osteoarthritis of the knee


Osteoarthritis is the most common form of arthritis in the world, affecting huge numbers of people and is a major cause of disability. As industrialized populations become older and live longer, the effects of osteoarthritis (OA) will become more marked.

New treatments are continually being developed as the understanding of OA moves forward rapidly.


The synovial fluid is the fluid secreted by the lining of the knee and other synovial joints. This fluid provides a useful function in the life of our knees. One of the main constituents of synovial fluid, hyaluronic acid, gives viscosity and elasticity to the fluid, allowing it to improve the way joints functions. In OA this viscosity and elasticity is reduced, and this may contribute to the abnormal functioning of the joint.

Viscosupplementation has been developed to replenish the hyaluronic acid part of the synovial fluid. This has shown some promise in improving the pain and abnormal function of osteoarthritic knees. Experiments have shown that adding hyaluronic acid to the cells in human synovial membrane stimulates them to produce hyaluronic acid themselves. Hyaluronic acid as a lubricant and shock absorber in the synovial fluid. It is not toxic when injected, has few side effects and has a rapid onset of action.

The concentration and molecular weight of hyaluronic acid in osteoarthritic joint fluid is reduced. Normal viscosity of the synovial fluid is vital to joint lubrication and is thought to have protective effects on the joint cartilage.


The technique involves the injection of 2ml of high concentration hyaluronic acid into the joint. This is usually repeated at weekly intervals for three weeks. This increases the concentration and molecular weight of the hyaluronic acid inside the joint. It also has an analgesic effect on the pain mediators in the synovium. The increased viscosity of the synovial fluid also has the effect of increasing joint lubrication, improve the nutrition of the chondrocyte cells in the articular cartilage, and control swelling of the joint.

Research work

Injection of hyaluran preparations has shown significantly greater pain relief than injection of a placebo; the effect is as good as taking anti-inflammatory medications. There is better pain relief than injection of steroids, and although the effect takes longer to develop it also lasts much longer than a steroid injection. The average time of pain relief is seven months. However 10% of people did not get any real pain relief. There are few complications to its use and these are usually mild and temporary.


OA costs enormous amounts of money and if this treatment reduces or puts off the need for arthroscopic surgery or total knee replacement, there could be a considerable cost saving. This treatment seems to be developing into an important treatment for OA joints.

Useful links

Arthritis Care

Complementary Medicine Association

National Ankylosing Spondylitis Society
Ankylosing Spondylitis is one of the commonest arthritic diseases, especially amongst young men. Although not usually severely disabling, it can have a big effect on a person's life.

National Osteoporosis Society

Arthritis Research Campaign
The ARC is the fourth largest medical charity in the UK and had an annual income of 26m in 2001-2. It funds research into all the different kinds of arthritis and provides information for professionals and the public.

Arthritis Resources - Comprehensive information
A comprehensive site devoted to arthritis and degenerative joint disease.




How to make an appointment

Contact us directly:
Andrea Beaumont An appointment may be booked directly through Mrs Andrea Beaumont, Personal Assistant to Mr David P Johnson, by telephoning (44) 0117 970 6655 or via our
e-mail contact form.

Appointments by referral::
Where a referral is from your GP or physiotherapist a letter will usually be provided including the details of any previous treatment received or other relevant medical details.

Useful information to bring to your appointment:
It is helpful if any previous X-rays or scans which are available are brought to the consultation, and the general practitioner may wish to provide the details of previous treatment received and other medical conditions.

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