Dr. Jay Kimmel’s Sports Medicine

        Many of our patients at Greater Hartford Orthopedics remain active for longer than ever before. More and more middle age and older men and women continue to exercise and play the sports they enjoy. Unfortunately some of them have knee pain.  In this age group, pain in the knee is often due to osteoarthritis (OA). While OA is frequently associated with aging, it can develop for a variety of reasons including obesity, mal-alignment syndromes or injury.

Usually, osteoarthritis develops over time and tends to worsen with age.  It results from the breakdown of cartilage and fluid in the joint.  Cartilage and fluid are essential components of a joint because they are responsible for cushion and lubrication. When these are lost, repetitive use of the knee can cause the surfaces of the bones to rub against one another leading to pain and stiffness.   In the knee, osteoarthritis can be very symptomatic because the knee is a weight-bearing joint that relies on cushion and lubrication for everyday activities such as walking, sitting, changing positions, and exercise.  Joint fluid therapy is a new form of treatment for patients with osteoarthritis of the knee.  Through a series of injections, joint fluid therapy can provide supplemental fluid and cushion in an osteoarthritic knee.

        It can sometimes be difficult to tell if you have osteoarthritis of the knee.  Common symptoms include pain and stiffness.  Patients tend to have these symptoms in the morning upon waking, when changing positions, such as getting in and out of a chair, and climbing stairs.  This may also be accompanied by swelling, even though there is generally no injury to the knee.  Patients may also experience a sensation of “grinding” coming from the knee, or “buckling” of the knee.  Muscle soreness or weakness of the leg muscles is also common.  The best way to diagnose knee OA is by seeing an orthopedist and having x-rays of the knee.

        There are several treatment options available for patients who have osteoarthritis of the knee.  Each patient with osteoarthritis of the knee presents differently because there are varying degrees of osteoarthritis, ranging from mild to severe.  Therefore, patients may respond to different treatments.  Conservative, or non-operative measures, include rest, ice, and physical therapy.  Anti-inflammatory medication such as Motrin, Ibuprofen and Advil can also help.  Sometimes, a cortisone injection can be performed.  If the osteoarthritis is severe or end-stage, joint replacement may be the only option. Many of our patients wish to remain active but wish to avoid joint replacement. Joint fluid therapy is useful for patients who have not benefited from conservative treatment, but who are not ready for knee replacement.        

The goal of joint fluid therapy is to restore the cushion and fluid in the knee.  Patients with osteoarthritis lack one particular element that is found in cartilage and joint fluid, hyaluronic acid.  Joint fluid therapy involves delivering hyaluronic acid to the joint through a series of injections.  At Greater Hartford Orthopedic Group (GHOG) in Connecticut, Dr. Jay Kimmel is performing joint fluid therapy in the office.   There are a variety of products on the market, however, the particular brands Dr. Kimmel uses are Supartz, Synvisc, and Synvisc-1.  Supartz and Synvisc are available in a series of 3 injections.  The injections are performed in a three-week series, each injection is done a week apart.  Synvisc-1 is a new product which delivers the same amount of hyaluronic acid to the knee, but requires only one injection.  In the office, Dr. Kimmel, or Elizabeth, his physician assistant, will perform the injection.  After the injection many patients return to their activities after 24 hours, however, Dr. Kimmel may advise you to rest for 48 hours.  Many insurance companies require pre-authorization for joint fluid therapy, so the injection or injections may not be done on your initial visit.  

         Many studies have demonstrated the success of Supartz, Synvisc, and Synvisc-1.  With Supartz, studies have shown that pain relief can start as early as after the first injection and can last for up to six months.   Patients treated with Supartz injections demonstrated a 50% decrease in their knee pain.  Clinical studies have also reported favorable results with Synvisc injections.  One study showed patients having pain relief as soon as one week after the injection.  The most pain relief and greatest amount of success were documented at two and three months after the injection.  Similarly, clinical studies of Synvisc-1 have shown that 71% of patients reported pain relief as soon as one month after the injection.