• Hyaluronan (also known as sodium hyaluronate or hyaluronic acid) is a natural and linear glycosaminoglycan, and is ubiquitous in all the tissues and fluids of animals, with the highest concentrations in soft connective tissues.

  • In 1934, Karl Meyer and his assistant John Palmer first announced the discovery of HA. They purified HA from bovine vitreous and showed that it contained a hexuronic acid and a hexosamine. They proposed “for convenience, the name hyaluronic acid, from hyaloid (vitreous) + uronic acid.” Up to the mid-1940s, HA had been isolated successfully from other sources- synovial fluid, skin, umbilical cord, cock’s comb, etc.

  • In 1980s, Dr. Endre Balazs and his coworkers developed a procedure to isolate, purify and identify hyaluronic acid from rooster combs and human umbilical cords. Since then, HA has been produced at industrial scale from rooster combs and human umbilical cords.

  • Discovered from bacteria.


  • It is known that the capsules of some bacteria contain HA, therefore, HA can also be isolated from certain strains of bacteria, such as streptococci, which was first reported in 1937 by Kendall et al. They cultured Group A streptococci and then the mucoid polysaccharide was precipitated with ethanol. This polysaccharide which was composed of N-acetyl glucosamine and glucuronic acid units was identical with that occurring in bovine vitreous humor and human umbilical cord. The bacterial production of HA involving a Streptococcus zooepidernicus strain was first described in 1989, giving rise to the first commercialization of HA produced by fermentation.

  • By the end of the 20th century, bacterial fermentation had become the leading production technique for sodium hyaluronate, and it has led to great changes in the sodium hyaluronate industry. The industry is now able to produce a higher quality HA product on an industrial scale necessary to support the continued expansion of HA applications into new areas of science. The techniques have also lowered the cost of HA production to a point that has allowed many applications to go mainstream that might have proved too costly for markets previously.

  • Commercial HA is commonly presented as the form of sodium salt.

  • During the manufacture of HA, sodium salts (such as sodium chloride or sodium hydroxide) are often used to increase ionic strength or to adjust pH value, therefore, most of HA products is presented as the form of sodium salt, named sodium hyaluronate.

Orthopedic products //

Diseases and treatments //

Joint Pain and Arthritis


With overuse or injury, cartilage on the end of the joints can break down, causing a narrowing of the joint space and the bones to rub together. Painful bony growths, or spurs, may form. This can lead to swelling, stiffness, and possibly osteoarthritis, the most common type of arthritis. Another type of arthritis is rheumatoid arthritis, an autoimmune disease characterized by extreme inflammation.



What is Osteoarthritis?


  • Osteoarthritis is a disease that affect the joints in your  body.

  • While it can affect any joint , osteoarthritis most commonly in the hands , hip, Knees, neck and lower back.

  • Osteoarthritis (OA) is the most common joint disease and cause of disabilities, especially in the elder people (more than 80 percent of the population over 55 years of age is affected by osteoarthritis).

  • Also known as degenerative arthritis, degenerative joint disease or OA, it occurs when the cartilage that normally covers and cushions the ends of bones wears down over time. It is characterized by cartilage erosion, changes in subchondral bone, osteophyte formation and synovial inflammation.

  • The main symptoms of OA are chronic pain, stiffness and loss of mobility.

How does OA develops?


  • Osteoarthritis is caused by cartilage resulting in a joint pain.

  • The smooth cartilage surface wear down. Then this happens, the cartilage loses its elasticity and more easily damage by excess use or injury.

  • With time section of cartilage may wear away completely. As a result the bone rub together.

  • As the cartilage wear down , the join may lose its normal shape. The bone end thicken. The bone at the edge of the joint mat grown outward and form body spurs.

  • Fluid – filled cysts may form in the bone near the joint . Bit of bone or cartilage may float loosely in the joint space.


Osteoarthritis of the Knee


  • When osteoarthritic joints became swollen and damaged , they can be painful and difficult to move.

  • If you have OA of the knee the symptoms pain, stiffness limited range of motion.

  • In the arthritic joints , the normal concentration and molecular weight of hyaluronate ( HA ) is decreased by 33% to 50%, limiting its role in maintaining normal joint biomechanics.



What is Viscosupplementation?


  • Viscosupplementation refers to a procedure that involves the use of HA solution to supplement or replace synovial fluid in joint with pathological conditions to alleviate pain and promote the healing of intra-articular wounds. The viscosupplementation should improve the physiological environment of an osteoarthritic joint by restore the protective viscoelasticity of synovial fluid, reduce friction, and improve mobility.

  • Studies have confirmed the satisfactory effect of HA to treat lameness in race horses and osteoarthritis (OA) in human knees, hips, shoulders, and temporo-mandibular joint, and so forth. The use of HA solution in OA treatment is considered to be the most successful medical applications of HA.

  • Viscosupplementation has as its therapeutic goal the restoration of rheological homeostasis in pathological structures such as osteoarthritic joints. When the normal viscoelasticity of a solid tissue compartment or the elastoviscosity of a liquid tissue compartment is decreased under pathological conditions, normal function and regenerative processes are impaired. By introducing viscosupplementary devices, the normal rheological state of such compartments is restored or augmented. These devices stay in the tissue compartment for various periods of time, depending on the nature of the viscosupplement and the pathophysiology of the tissue compartment.


Mechanism of action


  • Viscosupplimentation with HA  has various mechanism of actions on the osteoarthritic knee. In addition to repletion of intra -articular  HA and its viscous and elastic properties , HA also have anti inflammatory, anabolic  and analgesic properties.

  • HA   has been  identified as the molecule responsible  for imbuing the knee with this rheostatic  properties. HA  is polysaccharide chain composed of repeating disaccharide units of glucuronic acid and N –acetylglucosamine. HA is normally synthesized by tipe B synoviocytes or fibroblasts and is secreted into the joints. In the osteoarthritic knee  the concentration of HA is decresed  to nearly  one half of normal, the MW is reduced ( as polysaccharide chains are cleaved ) and this is decreased interaction between HA molecules. These   changes after the inherent viscous and elastic properties of HA  and reduces  the ability of the joint to resist stress and shear forces.

  • HA is viscoelastic substance because it exhibits  both viscous  and elastic properties. This allows  the joint  optimally adapt to different externally  applied forces. The knee experiences low shear loads  during simple range of motion. Under these conditions , viscous properties predominate and the HA  molecules line up and act as a lubricants . under high shear loads , HA molecules behave and an elastic substance and absorb energy that is transmitted across the joint.

  • Because native HA is decreased in the osteoarthritic knee and HA restores these lost viscoelastic properties , descriptions of these product as viscosupplements  seems  reasonable .