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Michael Price pushed the bottom of his pant leg up over his right knee and dangled his legs over the side of the exam table.
Few people are ever eager to get a shot, but Price was more than ready. The syringe next to the exam table was filled with a clear gel that would allow Price the freedom to walk farther with less pain.
Dr. Terry Clyburn, assistant professor in the Department of Orthopaedic Surgery at The University of Texas Medical School at Houston, cleaned and numbed Price’s knee, then quickly pushed the needle into the joint.
“It stings a little bit at first, and you feel a little pressure, but getting the injection is no big deal,” Price says.
While the shot, as Price describes it, may be no big deal, a growing number of osteoarthritis patients agree that the results from injections of hyaluronate are just the opposite. They can be a huge, life-changing deal, as the shots may postpone or even prevent the need for total knee replacement.
“The injection is a mechanical oiling of a joint that is wearing out,” says Clyburn, medical director of biomedical research and director of joint implant research at the UT Medical School.
Hyaluronate is a natural chemical that acts as a lubricant and a shock absorber in the joints. In healthy joints, hyaluronate is thick and oily, but in joints with osteoarthritis, it is thin and watery.
Injections of a highly-processed hyaluronate derived from rooster combs can plump up the patient’s own hyaluronate in the weakened joint.
“It stimulates your body to produce an improved quality of its own natural lubricants in the knee,” Clyburn says.
More cushion means less pain. For patients who aren’t responding to traditional anti-inflammatory medications and other non-surgical therapies for osteoarthritis, injections of hyaluronate may provide much needed relief.
“This is another option we have to continue conservative care until the patient absolutely needs surgery,” Clyburn says. “It can buy us time.”
Since the late 1990s, the U.S. Food and Drug Administration has approved four hyaluronan therapies for the treatment of osteoarthritis knee pain. These treatments also work well in elbows, shoulders and ankles, Clyburn says.
The injections are administered once a week for three to five weeks, Clyburn says and afterward, “most people get relief for six months to a year.”
The hyaluronan therapies have very few side effects, Clyburn says. It isn’t recommended to anyone with poultry allergies, but most people tolerate it well and start to see results by the second or third shot.
The therapy, he adds, is superior to steroid injections, which may provide short-lived pain relief but also slow the cartilage’s ability to heal.
“This is the best we have so far. Even people with bad arthritis – bone on bone – get good results.”
Price is one such patient. “After the second shot, I started to feel relief. There is a pretty significant improvement."
At the end of a busy day at work, Price no longer limps up the stairs of his townhome. The pain has diminished considerably.
Price has been coping with knee pain since he injured his leg in a motorcycle accident almost four decades ago. Since then, he’s had arthroscopic surgery and cortisone shots. Nothing worked as well as the hyaluronan therapy, says Price, now 59.
Because his arthritis is so severe, Price and his orthopedic surgeon agree that he is destined for a total knee replacement. But their goal is to use the hyaluronate injections as a bridge to surgery, which Price hopes to delay at least until he retires from his job as a geologist.
“Another reason I want to wait – you never know what they may develop in the next few years,” Price says. “They may come up with something even better and I can avoid knee surgery all together.”
UPDATED: 5-24-2006
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Dr. Terry Clyburn is an assistant professor and director of research in the Department of Orthopaedic Surgery at the UT Medical School.
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Tetanus booster for adults
Tetanus does not result from the rusty nail or whatever created the wound. The danger lies in the bacteria Clostridium tetani that lives in the soil or manure on that nail or gardening tool. When these spores get into a wound—deep or shallow—they can produce a potent toxin. Also called lockjaw, tetanus seriously affects the central nervous system and can be fatal.
Onset of symptoms can occur anytime from three days to three weeks. Call your health care provider if you have an open wound, particularly if:
Adults should have a tetanus booster shot every 10 years, known as the Td vaccine. It is a "2-in-1" vaccine that protects against tetanus and diphtheria. It contains a slightly different dose of diphtheria vaccine than what you received as a child. It can be given to anyone older than 7 years and is injected, usually into the arm.
Instead of the standard Td booster every 10 years, adults between the ages of 19 and 65 should receive Tdap one time in their adulthood to boost the immune system for pertussis, as well as tetanus and diphtheria.
Diphtheria, a contagious bacterial infection created that causes severe inflammation of the throat and larynx and can also affect the whole body. Pertussis or “whooping cough” is a serious bacterial infection that afflicted children and infants before vaccines were available. Adults may be infected later in life as their immunities wane. Neither of these infections are related to tetanus, but both vaccines are compatible and convenient to use with the tetanus booster.
