Hyaluronic Acid      

New procedure cuts through knee pain without a knife

Date: 9th December 2008, Source: Hyaluronic News

Athletes aren't the only ones who have knee problems.
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Osteoarthritis is the common malady that strikes nearly 5 million Americans per year and the knees are a prime target. Bad knees not only cause pain, they limit a person's activities and affect an individual's quality of life.


According to medical experts, osteoarthritis is not just a disease that is linked to aging -- three out of five people who are affected are under the age of 50.


With the Federal Drug Administration's removal of several popular drugs used to relieve osteoarthritis pain, patients and doctors are seeking new methods of treatment. Now, Dr. Fred Ginsberg, medical director of Associated Physicians Group, raises hope for the alleviation of chronic knee pain and offers sufferers a new method of relief without undergoing knee surgery.


The goal of the medical doctors, chiropractor and therapists at APG is to help people to be pain free said Jay Taddei, the chief operating officer of the company. Its motto is "It just makes sense."


According to Ginsberg, it makes sense to try something new before resorting to surgery or a total knee replacement because once the knee is replaced, you can't go back.


An internist and anesthesiologist, Ginsberg now devotes himself to pain management and non-operative treatment of the knee. After studying the treatment of knee problems by the injection of hyaluronic acid, Ginsberg's research led to the work of Dr. David Waddell, professor of orthopedic surgery at Louisiana State University Health Science Center in Shreveport, La.


Waddell was having success with fluoroscopy-guided injections of the hyaluronic acid into the knee joint using a contrasting dye for accuracy. Ginsberg takes it further by incorporating the Theraciser program as part of the treatment.


Simplifying the description for the lay person, Ginsberg compares the joint to the metal parts in an automobile engine which must be lubricated to keep metal from grinding on metal. The motor oil must have a certain thickness or viscosity to be effective.


The synovial joint fluid in the knee is comparable to the motor oil, but the knee also has cushions of cartilage which are lubricated and nourished by the synovial fluid. As the body ages, it produces less synovial fluid causing the cartilage to thin and break down until there is little or no cushion left between the ends of the thigh bone and the shin bone where they meet in the knee joint.


Ah, there's the rub, well, grind, and thus the pain.


Some symptoms of osteoarthritis include, morning stiffness, pain on going up or down stairs, cracking and popping, redness and swelling.


Ginsberg said patients are rated for the severity of their problem on a gradient system that looks at four conditions with each condition rated 1 to 4, comparable to 1 being mild, 2 being mild to moderate, 3 being moderate to severe, and 4 being bone on bone.


Ginsberg calls it the Rice Krispies sound.


"Hardly anybody wants to treat a 4," he said. "The way our program is designed even a high 4 can have some degree of relief."


Using Hyalgan, a purified form of the natural chemical hyaluronan that is found in the body, Ginsberg injects it into the very narrow space between the cartilage and the bone, guiding it with the aid of the fluoroscope. The next part of the treatment is what really makes it effective, he said.


The patient is put into the Theraciser Rehab program where gentle but effective movement of the knee joint acts like a pump, increasing the effect of the Hyalgan injection. One effect is to make the synovial fluid more viscous and thus more effective at what it's supposed to do.


Ginsberg said the result of the treatment is decreased pain, decreased inflammation, and perhaps most important, the stimulation of new cartilage growth.


So far, the FDA has only approved this treatment for knee joints, but by July, Ginsberg said it will be approved for use in shoulder joints. He said the United States is always years behind other countries in approving new drugs and this treatment has been available in Japan and Europe where it is also used by dentists to treat TMJ syndrome and by ophthalmologists for certain types of ocular surgery.


"We believe in pain-free rehabilitation," Taddei said. "If it hurts, you'll just increase the inflammation. If you rehab through pain, you'll get an inflammatory response. Very few physical therapy facilities do high-speed motion. Our method uses high speed motion to actually pump the fluid into the joint."


Taddei emphasized that APG with offices in Glen Carbon, O'Fallon, Freeburg, and soon to be in Swansea, is an integrated medical practice with three medical doctors and a chiropractor on site. There are also three physical therapists, a nurse practitioner and physicians' assistants.


"We don't do family practice," Taddei said. "We specialize in getting people out of pain. Anytime you can prevent surgery, it's a good thing."


He said there are very few places in the country that are offering this type of treatment. Ginsberg said it is offered at Duke University and maybe in California. His patients travel many miles to get the treatment. One man came three times a week for two months and now he is able to take his wife dancing.


The ones the APG team points to with satisfaction are the ones who couldn't walk without assisting devices before participating in the program and who are able to walk on their own now without discomfort.