A therapeutic analysis of hyaluronan fluid flow in damaged medial/lateral menisci in arthritic patients

Abstract

Osteoarthritis is a common type of arthritis that breaks down the joint tissue, known as cartilage. This causes the bones to rub against each other, causing pain and loss of movement especially in weight-bearing joints in the knees, hips, feet and the back. In recent years, synovial fluid therapy is often used in patients with Osteoarthritis, where the fluid is directly injected into the tissue which acts as a lubricant in the joint. The fluid is based on Hyaluronan (HA), a pure solution of sodium hyaluronate and is a natural constituent of the human body. This study deals with the simulation and analysis of the Fluid Therapy and an aim to optimize the procedure as a function of characteristics and also disease stage. The tissue or cartilage has been modeled as biphasic and the simulation has been done using Fluid-Structure interaction using Sysnoise, commercially available FEM software. Different case studies related to cartilage damage have been analyzed and the results have been compared with the actual therapeutic procedure of fluid therapy. The results are provided in terms of the fluid velocity that helps the fluid to void the space inside the cartilage or the synovial joint. During actual fluid therapy, the fluid is expected to void between a period of 7 – 14 days, which is why the injections are give either weekly or biweekly. Results show that few patients, suffering from arthritis, can experience relief for a period of up to six months with the help of fluid therapy, with appropriate quantity of fluid and the concentration of HA in the fluid among other conditions. The present work provides an opportunity to optimize the fluid therapy procedure based on parameters, such as fluid volume and its thermophysical properties. Results from the study indicate that treatment can be custom designed by considering the concentration of HA in the synovial fluid injection, its viscosity, the weight and condition of the patient and the stage of the disease. With fluid therapy being considered increasingly, optimization procedure would be of valuable medical help and of substantial economic benefit to patients.