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Friday, March 17, 2000

Surgeons seek nonsurgical treatment of joint diseases

As the prevalence and incidence of knee osteoarthritis increases, orthopaedic surgeons are searching for treatments for the degenerative joint disease. Some of the treatments under clinical review include the injection of hyaluronic acid, which serves as a viscous lubricant for the joints.

"The viscosity of the fluid seems to insulate the knee joint in the same manner that a lube job helps your car function properly," said Randy Rosier, MD, professor of the department of orthopaedics at the University of Rochester in upstate New York. "We're not exactly sure how it works, but preliminary trials seem to indicate that it results in a reduction of pain."

The procedure involves 3 to 5 injections of the hyaluronic acid once per week for patients experiencing knee joint pain and discomfort. The technique has received FDA approval and significant improvement, especially among elderly patients, is typically experienced within 6 to 8 weeks of the initial treatment.

Dr. Rosier said the FDA-approved fluid also has been used as a treatment for dogs and horses. While all joints have synovial fluid, the FDA has only approved the procedure for use on knees. Apparently, elbows and shoulders will not receive the early benefits of the rooster remedy.

Other approaches to knee osteoarthritis include the use of knee braces and heel wedges, mechanical measures which seem to open cartilage space and relieve tension around the knee joints. Douglas A. Dennis, MD, clinical director at the Rocky Mountain Musculoskeletal Research Laboratory in Denver, Colo., said the non-invasive techniques help to offload pressure on the joints, realigning the leg to promote more stability and less pain.

"The braces create an angular correction that creates condylar separation," Dr. Dennis said. "Condylar separation does occur in 75 percent of the patients who use braces and heel wedges, but the best results occur in nonobese patients."

The braces can be taken on and off by patients without medical supervision. The heel wedges insoles are placed in shoes and are believed to reduce pain and improve walking among osteoarthritic patients.

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Last modified 17/March/2000 by IS