Therapy for osteoarthritis
Osteoarthritis is a problem that many of us share and is one that is a significant cause of pain and loss of function for many patients.
The end stage of this disease results in the patient having to undergo total knee arthroplasty. This is a very good operation when other alternatives fail to provide a functional lifestyle with manageable pain. More than 400,000 total knee arthroplasties, also known as total knee replacements, are done each year. The outcomes are generally very good, but with all surgery, there can be medical and surgical complications. If you can get a good level of pain relief without undergoing surgery, most people will opt for that choice. Delaying TKR is an option that many people desire. There is a treatment that can do just that.
Viscosupplementation is a therapy for osteoarthritis of the knee that was introduced to the United States in 1997. I had the good fortune of being one of the first physicians to adopt this therapy into practice and have seen it save many people from having to have a TKR. I, myself, have had eight courses of viscosupplementation for osteoarthritis that developed as a result of an old football injury. The treatment has given me dramatic pain relief and that is one reason that I am a major advocate for the therapy.
When it was first introduced into the United States, it was felt that the viscosupplements were functioning completely as lubricants. In fact, they are listed by the FDA as temporary synovial prostheses.
I and others have done significant research to demonstrate that there are biologic effects from these devices and they actually are more like drugs than they are devices.
Regardless of what they are called, they have been shown to have a dramatic positive effect on the pain of osteoarthritis of the knee.
I have presented more than 150 scientific papers and published articles in journals dealing with osteoarthritis showing that this treatment can effectively delay total knee replacement for a long time.
Some people never have to have the surgery because the treatment keeps them functional until they have completed their life.
For many people with medical conditions that prevent them from having TKR surgery, the treatment gives them a new look on life.
There are five different viscosupplements on the market today in the United States. The market leader is Synvisc. That product is the one that I have had placed into my knees, and it is the one that I recommend to my patients.
With a single injection, their pain can be effectively treated for many months.
The package insert on the Synvisc box states that the relief can last up to six months, but my experience has been that the effect usually lasts much longer. Most patients get almost a year’s relief with one injection.
The other products on the market require between three and five injections. To get six months’ duration of efficacy, most require the five-injection protocol. Synvisc can help with just one injection.
That is one of the major factors in making my decision for not only myself, but also for framing my recommendation for my patients.
It is very important that the injection be placed very precisely.
For this reason, I have developed a special technique utilizing fluoroscopy to determine needle placement into the knee joint.
This technique was published in The American Journal of Medicine and Sports in 2000. Since that time, I have taught and demonstrated this technique at meetings across the United States as well as in Europe, Africa and Asia. Most of the companies that produce the viscosupplements have now also recognized this fact and teach similar courses.
Viscosupplementation has been a major development in the treatment of osteoarthritis. It will continue to improve. Newer treatments will require fewer injections and hopefully will last longer.
If you have questions regarding this or other specific health questions, ask your doctor. He or she will be glad to answer them.
Dr. David D. Waddell specializes in arthroscopic and reconstructive procedures of the knee, total joint revision and viscosupplementation. He has guided the success of Orthopedic Specialists of Louisiana for over 35 years. Waddell also developed the CBTI-Waddell Patellar Alignment and Cutting Guide in collaboration with the Biomedical Research Foundation of Northwest Louisiana, and is a design surgeon for Wright Medical Technology and the EVOLUTION Total Knee System. He holds several patents for the treatment of osteoarthritis and has treated over 10,000 patients with knee disorders.
