Synovial Fluid Replacement – This is something that actually works

By: Michelle McDonagh – – Wednesday, April 21, 2010

This time last year, Pat Spillane was in constant pain, had difficulty walking and standing and was unable to sleep or to perform his job as a PE teacher.

One year on, he has gone from being “a virtual cripple” to being able to lead a normal life again. Although he accepts that he will never jog or run again and still cannot walk or stand for very long periods, he has a much better quality of life with limited pain and much greater mobility and he has returned to work.

Pat attributes the vast improvement in his condition to a new therapy called Synovial Fluid Replacement Therapy, which although growing in popularity worldwide, is still relatively unknown in Ireland.

The former Kerry footballer, who is regarded as one of the great players of his generation and a key member of the successful Kerry teams of the 1970s and 1980s, was left with a lasting legacy of his footballing days – a “fecked up” knee.

In fact, Pat Spillane’s knee was once the most famous knee in the country, even ending up on The Late Late Show. In 1981, Pat ruptured his anterior cruciate ligament, an injury which at that time invariably spelt the end of a footballer’s career.

However, after undergoing surgery on his knee in Cambridge, England in 1982, he became the first Irish sportsman to return to play at top level after sustaining such an injury. And what a successful comeback he made, going on to win three All-Ireland Senior Football Championships Medals in 1984, 85 and 86 to add to the five he already boasted.

The Kenmare native went on to play club football for another seven years after that and played and trained into his early 40s, “getting another 21 years out of the knee”.

However, his early injury came back to haunt him about six years ago and on top of that, he began to suffer from arthritis in his knee. He had a number of operations to scrape out cartilage in his knee, but by 2005, he was unable to walk properly or stand for any length of time, was being kept awake at night with the constant pain and had to take time off from work.

When he saw the new lease of life that his 80 years old mother got from a knee replacement, he went to see orthopaedic consultant, Mr Richard Creedon at the Bon Secours in Cork last year to discuss having a similar operation.

Pat explains: “I will have to have a knee replacement because my knee is such a mess but at 50, my consultant told me I was too young to get one. There is a danger if you get it done too young that you will be overly active and reduce the lifespan of the knee. You would need a second replacement then and there is quite a high risk that it would not be as successful as the first.”

It was at this point that his consultant offered Pat the option of Synovial Fluid Replacement, a therapy he had never heard of. The fluid was injected into the synovial cavity of his knee where it basically acted as an oil to lubricate the joint.

Three weeks on, after his third injection, Pat was back walking again and within six months of starting the therapy, he was leading a fairly active life again. As well as working full-time as a PE teacher, he presents The Sunday Game for RTE during the summer and writes a weekly GAA column for The Sunday World.

“This is something that actually works and the majority of GPs and many orthopaedic surgeons know nothing about it. There are people out there suffering, taking pain killers and anti-inflammatories which have side effects and can actually cause more damage who know nothing about this treatment which is not expensive,” he says.

Osteoarthritis in Ireland

Osteoarthritis is one of the most common chronic diseases and the most frequent cause of pain leading to long term disability in the older population in Ireland. Every year, around 400,000 people in this country consult their doctor with symptoms related to arthritis.

The incidence and prevalence is higher in women than in men, especially after the age of 50 and chronic cases lead to the need for joint replacement. The disease occurs most frequently in the knees, hands, thumb base, hips, back, neck.

Sports people who suffer cartilage injuries as well as wear and tear to the joints are more susceptible to developing arthritis in later years.

A sticky or squeaking hinge can be ‘cured’ with a drop of oil, so it makes sense that a hinge joint, like the knee, would also benefit from a little lubrication – at least, that’s the premise behind one new form of treatment for arthritis of the knee.

The procedure, called viscosupplementation or Synovial Fluid Replacement injects a preparation of Sodium Hyaluronan into the knee joint. Sodium Hyaluronan is a naturally occurring substance found in the synovial (joint) fluid. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads.

Derived from naturally occurring biological substances, Synovial Fluid Replacement Therapy is injected into the synovial cavity of a joint once a week for three weeks. For a patient with mild to moderate osteoarthritis, studies have found that three injections will provide pain relief for up to six months, while those with a more severe form of the disease will need more injections.

Synovial Fluid Replacement Therapy is available on the General Medical Scheme in Ireland since February 1, 2005.

Traditionally, weight loss, physiotherapy and exercise are recommended in the treatment of osteoporosis. If this is unsuccessful, analgesics as well as anti-inflammatory drugs and steroids may be used to relieve pain – but the effects, even of steroids, are short lived.

Consultant orthopaedic surgeon at Mayo General Hospital and the Galway Clinic, Mr Derek Bennett has been using Hyaluronan acid treatment in his patients for the past three years with good results.

“I think it’s a great tool that is part of the equipment we can use against osteoarthritis of varying stages. For a lot of people with moderate arthritis that is not bad enough to require knee replacement surgery, it’s a fantastic, simple, safe and effective method for them,” he says.

Mr Bennett advises his patients to return to him once their pain returns – some return a year after treatment while others get two years out of it.

However, he points out that the viscosupplementation procedure does not work for everybody and is totally ineffective in the treatment of rheumatoid or any kind of inflammatory arthritis.

“It’s not a magic cure. It won’t take away the need for a knee replacement but it could delay it for many years in people with mild to moderate osteoarthritis. The downside is that it doesn’t work for everybody, only those with osteoporosis and even then, it doesn’t work all the time,” Mr Bennett explains.

Having said that, he points out that people who are worried about having to go for major surgery are usually very happy to have the three injections instead and it is a very effective procedure in some patients.

For further information on arthritis or Synovial Fluid Replacement Therapy, go to


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