Viscosupplementation for Osteoarthritis of the Knee

A 67-year-old woman with right-knee osteoarthritis is referred by her primary care physician for treatment of her knee pain. The patient weighs 83 kg and is 161 cm tall, and her body-mass index (the weight in kilograms divided by the square of the height in meters) is 32. She has had pain intermittently for 9 years, which has been relieved with infrequent use of naproxen. She has recently become more sedentary and is finding it increasingly difficult to play golf. A recent radiograph of her right knee reveals moderate joint-space narrowing and osteophytes, affecting primarily the medial tibiofemoral compartment and lateral patellofemoral compartment. A friend at her golf club received a hyaluronate injection and had sustained relief of her knee pain for 6 months. The patient inquires about whether this form of therapy may be appropriate for her. The specialist recommends weight loss and exercise and counsels the patient about the appropriate use of viscosupplements.