Health & Exercise Forum

AN ALTERNATIVE TREATMENT FOR ARTHRITIS

At least once a week, a patient jokingly asks if they can get a “lube job” to loosen up their stiff knee joint. I respond by providing them with information about osteoarthritis and viscosupplementation, a conservative treatment administered by injection and approved by the FDA for the treatment of osteoarthritis of the knee.

Do You Have Osteoarthritis?

Osteoarthritis (OA) is also known as degenerative arthritis. It is the most common form of arthritis in the knee. OA is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the knee joint which eventually wears down to the bony joint surface. It is most often found in middle-aged and older people and in weight bearing joints such as the hip, knee and ankle. Symptoms include: pain, swelling, stiffness, weakness and loss of function.

Your family physician will examine your knee to determine if you have arthritis. In more advanced cases you may be referred to an orthopedic surgeon or rheumatologist for further examination and treatment. It will then be determined if you are a candidate for viscosupplementation. While this procedure is the most commonly used in the knee, it has also been used for osteoarthritis in the hip, shoulder and ankle.

Procedure

Viscosupplementation is a procedure, usually performed by an orthopedic surgeon or rheumatologist, in which medication injected into the knee joint acts like a lubricant.

The medication is hyaluronic acid is a natural substance that normally lubricates the knee. This natural lubricant allows the knee to move smoothly and absorbs shock. People with osteoarthritis have less hyaluronic acid in their knee joints. Injections of hyaluronic acid substances into the joint have been found to decrease pain, improve range of motion and function in people with osteoarthritis of the knee.

When conservative measures, such as anti-inflammatory drugs, physical therapy, steroid injections fail to provide long lasting relief, viscosupplementation may be a viable option. Often, physical therapy and exercise are more effective following this injection to provide additional long-term benefit. Unfortunately, if conservative measures, including viscosupplementation fails, surgery, including a joint replacement may be the next alternative.

In 1997 the FDA approved viscosupplementation for osteoarthritis of the knee. Presently, there are several products on the market. One type is a natural product made from the comb of a rooster. However, if you are allergic to eggs or poultry products or feathers, you should not use the natural product. The other medication is best used for patients with allergies because it is manufactured as a synthetic product.

Effects

Short-Term:

• No immediate benefit
• May have a localized pain, warmth, and swelling after the shot. Use ice to control symptoms for 1-2 days
• Should not overexert for 1-2 days after the injection

Long-Term:

• Less pain with daily activities
• Less inflammation
• Stimulates body to produce its own hyaluronic acid to lubricate the joint
• Last for 6-9-12 months

Some Product Options

• Synvisc^R – Hylan G-F 20 by Genzyme Corporation requires 3 injections 1 week apart.
• Hyalgan^R – Sodium Haluronate by Sanofi-Synthelabo, Inc. requires 4 injections 1 week apart.
• Supartz^R – Sodium Haluronate by Seikagaku Corporation requires 5 injections 1 week apart.

The long-term effects of viscosupplementation is much greater when other conservative measures are employed:

• Orthopedic Physical Therapy: heat, cold, ultrasound, electrical stimulation, joint mobilization, range of motion exercises, strengthening exercises, partial weight bearing aerobic exercises.
  • Range of Motion Exercises: to keep knees flexible bend and straighten knees 10 times every 2 hours.
  • Strengthening Exercises: to keep legs strong
    • Better to perform sitting, partial or non weight bearing
      • Hip Hikes
      • Straight Leg Raise
      • Short Arc Quads
      • Quad Sets
      • Stand Ham Curl
      • Calf Raise
    • Partial or Non-Weight Bearing Aerobic Exercises:
      • Swimming
      • Pool Walking
      • Bike – Regular or Recumbent
      • Elliptical
      • Soft Bed Treadmill
• Activity Modifications: such as eating well and losing weight, doubles tennis instead of singles, sitting or lying leg exercises instead of standing, walk instead of run, soft bed treadmill instead of hard surfaces, avoid squatting, kneeling, and bending.
• Supportive Devices: such as knee sleeves, light bracing, use good running shoes for exercise and walking, use good quality supportive shoes for work/dress.

SOURCES: Genzyme Co, Sanofi-Synthelabo Inc, Seikagaku Co. and American Academy of Orthopaedic Surgeons

Visit your doctor regularly and listen to your body.     

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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!