Infiltrações de joelho
Recentemente, muito tem-se ouvido falar na realização de infiltrações intrarticulares do joelho. Precisamos entender que as infiltrações do joelho podem conter variadas substâncias infiltradas. Dentre os componentes mais comuns das infiltrações estão os anestésicos (xilocaína e lidocaína), corticóides (triancinolona e dexametasona) e ácido Hialurônico.
A articulação normal do joelho apresenta um líquido no seu interior que tem a função principal de nutrir as células da cartilagem, diminuir o atrito da articulação e amortecer a carga que passa no local. Quando a articulação do joelho apresenta um processo degenerativo como a artrose, este líquido sinovial (líquido transparente e viscoso das cavidades articulares e bainhas dos tendões) sofre modificações e perde as funções originais citadas acima, levando a um maior desgaste da cartilagem e piora dos sintomas.
A viscossuplementação ou infiltração de ácido hialurônico (substância naturalmente presente no organismo humano) têm a função de restabelecer a quantidade de ácido hialurônico “perdida” no líquido sinovial e restaurar a função do líquido sinovial normal.
Na nossa prática de atendimento a pacientes com artrose, sempre começamos com uma abordagem multidisciplinar. O paciente deve seguir orientações nutricionais, fisioterápicas, realizar atividades de baixo impacto (bicicleta e hidroginástica) e seguir o tratamento medicamentoso prescrito por um ortopedista. Na falha do tratamento inicial da artrose do joelho, a viscossuplementação está indicada. Estes pacientes com artrose do joelho que não respondem ao tratamento clínico inicial são os que mais se beneficiam da viscossuplementação.
De acordo com um estudo internacional (Wang et al. 2004), a infiltração intra-articular de ácido hialurônico e seus derivados é indicada para pacientes com artrose associada a dor, apresentando menor eficácia nos pacientes com estágio avançado da doença. A viscossuplentação / infiltração com ácido hialurônico pode ser realizada na clínica ou consultório com os devidos cuidados de higiene e antisepsia, devidamente aplicada por um ortopedista qualificado. A viscossuplentação / infiltração com ácido hialurônico pode ser realizada com anestesia local para minimizar a dor durante a aplicação. O número de aplicações depende basicamente da marca de produto a ser utilizada.
Atualmente, o mercado brasileiro apresenta produtos que podem variar de 1 a 5 aplicações. A infiltração com ácido hialurônico ou viscossuplementação é considerado um procedimento de alto custo. Alguns convênios apresentam cobertura para realização deste procedimento.
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