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Medical Articles »Victoria Barber, M.D.
What's New in Orthopedic Knee Treatment?
Victoria Barber, M.D.
Orthopedic Surgery
Hyalgan, For the Treatment of Osteoarthritis of the Knee Joint
Osteoarthritic knee joints often result in decreased worker productivity. At times, this condition could also affect workers' compensation medical-legal issues such as extended periods of temporary total disability, permanent disability and vocational rehabilitation. Frequently, the initial conservative measures employed fall short in relieving a patients painful arthritic complaints. Nonoperative early conservative treatment modalities include the use of nonsteroidal antiinflammatory agents, rest and occasionally joint unloader bracing. The use of physical therapy aimed specifically at strengthening of the quadriceps and hamstrings is also an important early treatment modality. However, when these options fail to provide effective long-term relief, the orthopaedist must seek alternative treatment. For many years corticosteroid injections have been utilized in the treatment of arthritic joints recalcitrant to oral antiinflammatory medications.
The introduction in recent years of Hyalgan for the treatment of osteoarthritis of the knee joint has proven an important advancement. The active ingredient in Hyalgan is sodium hyaluronate. Hyaluronate is a natural substance that acts as a lubricant and shock absorber in healthy joints. In osteoarthritis, hyaluronate is thought to be present in diminished quantity. Replacing this naturally occurring component of joint fluid may provide pain relief and increased function in patients who have failed other treatment protocols.
So, who should receive this treatment option? Patients who have failed treatment with nonsteroidal antiinflammatory drugs (Nsaids) or those who are not candidates for Nsaids due to gastrointestinal ulcer history or other medical conditions should be considered for Hyalgan therapy. Hyalgan should also be considered for the patient with function limiting osteoarthritic knees in order to avoid or delay surgical treatment. Such treatment can prolong an individual's productivity in the workplace. In the young patient with post traumatic osteoarthritis or in those who have previously undergone total meniscectomies, Hyalgan treatment can alleviate symptoms allowing a return to an active life style.
Hyalgan is administered by an orthopaedist as a series of five weekly intraarticular injections. Although an initial positive effect may not be noted until after the fifth injection, many patients note improvement in night pain and the discomfort associated with activities such as stairclimbing early in the treatment series. Several studies have indicated that the Hyalgan therapy can relieve pain for six months.
My personal experience with Hyalgan, although limited has been quite promising. Two of the patients in my series had quite demanding jobs requiring prolonged standing and walking (a waitress and a nurse). Prior to treatment and despite the use of several antiinflammatory agents, intraarticular corticosteroid injections and physical therapy, both these individuals were severely limited in the performance of their job duties by their arthritic knees. Following Hyalgan treatment, these patients were able to return to full duty. In these cases, Hyalgan provided an answer to a treatment dilemma. In short, the addition of Hyalgan to my armanentarium in treating osteoarthritis of the knee has greatly improved my nonoperative management of this disease process. Hyalgan treatment for those patient's who meet the criteria could reduce extended periods of lost time from work, decrease the level of permanent disability, avoid complications from costly surgery, facilitate a return to a productive work force and improve their quality of life.
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