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Study: Combining Two Standard Treatments Can Give Patients a Leg Up on Knee Arthritis

(New York, N.Y. January 18, 2009). Two treatments generally used separately to relieve knee pain can work better when combined, according to a recent study in the American Journal of Orthopedics. Dr. Geoffrey Westrich, co-director of Joint Replacement Research at Hospital for Special Surgery in Manhattan, found that arthroscopic surgery followed by three injections of a hyaluronic acid product relieved pain and improved mobility better than arthroscopic surgery alone. Arthroscopy is a minimally invasive procedure in which doctors make tiny incisions and use a video camera to see inside the joint.

Patients in the study had early-stage knee arthritis and a torn meniscus cartilage causing symptoms. Dr. Westrich evaluated the safety and efficacy of Hyalgan injections after knee arthroscopy. Hyalgan is an FDA-approved medication similar to the synovial fluid found in normal knees. Synovial fluid acts as a lubricant and shock absorber.

Forty-six patients in the study were divided into two groups. In one group, Dr. Westrich performed arthroscopic surgery to repair the torn cartilage, and then gave patients three injections of Hyalgan. Patients received the first injection in the operating room, immediately after surgery; the second injection within two weeks of the procedure; and the last one within three weeks of the operation. The second group of patients had minimally invasive surgery to repair their torn cartilage, but did not receive Hyalgan. The groups were compared three months and six months after surgery.

The injection patients had significantly less pain at the three-month follow-up and more flexion at the six-month follow-up, according to Dr. Westrich. Flexion refers to the ability to bend a joint. These patients were also significantly less likely to experience tenderness, pain on motion and crepitus (grating or popping sounds and sensations experienced in a joint) at the three and six-month follow-up appointments.

"We found that arthroscopic knee surgery combined with Hyalgan injections was more effective than arthroscopy alone in alleviating pain and restoring motion and function," Dr. Westrich said.

Osteoarthritis of the knee is a wear-and-tear disease affecting millions of Americans. Ranging from very mild to very severe, in advanced stages it can cause unrelenting pain and severely limit the ability to perform basic activities. For the most part, knee arthritis affects middle-aged and older adults.

"Without proper treatment, arthritic joints tend to deteriorate further, causing more problems for patients later on," Dr. Westrich said. "Our goal in the study was to help patients get a handle on their arthritis before it got worse. Longer follow up would be needed to determine if the combination of knee arthroscopy and hyaluronic acid injections has the potential to further slow the advance of osteoarthritis, in addition to providing more pain relief and functional ability than arthroscopy alone."

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