For many years we have injected joints with
cortisone. Now there has been a new breakthrough in the treatment
of knee osteoarthritis with a new substance. Instead of cortisone,
it is a naturally occurring substance that is normally found
in high concentration in a knee joint. This substance is
known as HYALURONATE.
Unfortunately with wear and tear problems
in the knee the levels of this substance drops as the knee
becomes more damaged. To counteract this abnormally low level,
the knee can now be injected with a purified form of this substance
which is obtained from rooster combs. This is particularly
attractive because instead of using a substance that does not
belong in the knee (cortisone), you are actually simply replacing
the lubricant that belongs there.
What is HYALURONATE?
This naturally occurring chemical is actually
a lubricant and a shock-absorber. It allows the knee to be
as frictionless as possible. In fact, there is no artificial
substance that has ever been developed that can be as slippery
as the normal knee joint. HYALURONATE, for lack of a better
description, can be though of injecting "grease" into
our cars’ universal joints. It’s even better than
that because it has a secondary effect as a shock absorber.
Who Can Use It?
HYALURONATE is usually indicated for people
with mild to moderate osteoarthritis or wear and tear changes
in the knee. It used when these people have not received relief
from painkillers such as Tylenol and physical therapy. It avoids
the side effects of anti-inflammatories such as Ibuprofen and
Naproxen. If you have severe osteoarthritis your knee may be
too far gone to benefit from this medication. A severely mal-aligned
limb similarly may not benefit as much.
What to Expect
Like all injections, you may have some
temporary but minor pain at the injection site. Occasionally,
there is a local irritation. You need to get to receive three
to five injections on a weekly basis before the medication
will work. It reaches maximum benefit at eight to twelve weeks
and can last six months to a year.
Contraindications
You should not receive these injections
if you are allergic to similar products such as feathers, eggs,
and poultry. You should also not have an injection if you have
a local skin disease such a rash or infection. There are some
possible risks such as allergic reaction. Infection can occur
but should be quite rare if proper sterile technique is used.
Like any injection, you may feel faint, drop your blood pressure,
or feel unwell. This is rare.
Things to Know
Immediately after the injection, you have
to take it easy and ice your knee. Expect to take two days
off of vigorous activity such as jogging or standing on your
feet for long periods of time. The safety of the medication
in pregnant women and in children has not been established.
There have been studies done in Germany and the United States
to establish its safety in the general population. It has actually
been used since 1987 in Europe, South America, and Asia. You
can take virtually any medication at the same time as receiving
this injection without any cross-reaction.
What About Cortisone?
Cortisone is still a good drug. It is a
better drug than HYALURONATE if there is an underlying inflammatory
component to the problem in the knee. In general, any problem
occurring outside the joint such as a tendonitis would not
respond to HYALURONATE. Instead, if you have to have an injection,
it would be cortisone. We tend to use cortisone in the more
severely advanced stages of osteoarthritis. Both medications
have their place and you cannot say that one is better than
the other. It is simply that they have different indications
in different people.
Ask Your Physician
You should speak with your orthopedic surgeon
whether or not you are a candidate for this |
