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Rheology of synovial fluid with and without viscosupplements in patients with osteoarthritis : a pilot study Bhuanantanondh, Petcharatana

Abstract

Osteoarthritis (OA) is a degenerative joint disease that is characterized by the breakdown of articular cartilage. Over 80% of people over the age of 60 show radiographic evidence of OA. Rheology of synovial fluid is of interest because of its significance in the joint lubrication. However, there are still many questions related to synovial fluid rheology and its relation with OA. Although viscosupplementation has been used as a treatment for OA for many years, its clinical effect remains controversial. Therefore, the purposes of this pilot study were to determine rheological behavior of synovial fluid in patients with OA to better understand its role in joint lubrication, and to determine in vitro the effect of different viscosupplements on the rheological properties of synovial fluid. A detailed rheological characterization of synovial fluid from 22 patients undergoing total knee arthroplasty was performed. The results showed that synovial fluid in OA exhibited a non-Newtonian shear thinning behavior and viscoelastic properties. Within an individual, rheological properties of synovial fluid from the left knee differed substantially from the right knee. Moreover, rheopectic behavior (i.e. shear stress increases over time at a constant shear rate) was observed in OA synovial fluid. All three viscosupplements considered in this study (i.e. Orthovisc®, Suplasyn®, and Synvisc®) exhibited a non-Newtonian shear thinning behavior. Within the range of frequency from 0.1 to 10 Hz., Orthovisc® exhibited a linear viscoelastic behavior, whereas Synvisc® and Suplasyn® exhibited a gel-like behavior and a viscous-like behavior, respectively. By adding viscosupplements to OA synovial fluid, the results showed cross linked high molecular weight viscosupplement is more efficient than the non cross-linked ones in improving the overall rheological properties of synovial fluid. Furthermore, rheological properties of synovial fluid mixed with viscosupplements in vitro were nearly unchanged over 2 weeks. In conclusions, synovial fluid in OA exhibited a non-Newtonian shear thinning behavior, viscoelastic properties, and rheopectic behavior. Cross-linked viscosupplement is more efficient than the non cross-linked ones in improving the overall rheological properties of synovial fluid. The rheology of synovial fluid mixed with viscosupplements was nearly unchanged over 2 weeks.

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