Leadership Forum: Over 12,000 SYNVISC injections — that’s a significant number. How has viscosupplementation changed the way you treat OA knee pain?

David Waddell: It’s given me an effective and well-tolerated option for those patients who have failed on other conservative treatments. I have a knee-only practice, so I see a lot of patients who have already run the range of nonpharmacologic and oral therapies for knee OA, including physical therapy, analgesics and NSAIDs. For these patients, viscosupplementation has become one of my primary treatment considerations.

I also see a significant portion of patients, referred to my practice by other physicians, who might otherwise be candidates for knee replacement. Viscosupplementation is a viable alternative for those patients who would like to avoid, or at least delay, surgery.

Leadership Forum: You’ve spoken many times on the dramatic increase in the incidence of knee osteoarthritis among baby boomers. To what do you attribute this increase?

Nicholas DiNubile: Based on the kind of middle-aged patients who present with knee OA in my practice, I think the reason for this “boomeritis” is twofold. First, a lot more of these people are staying active later — compared to prior generations, a significantly larger proportion of the boomer generation are participating in sports and fitness activities, putting added strain on aging knees. At the other end of the spectrum, a key risk factor for knee OA is obesity. Ironic, isn’t it?

Leadership Forum: Where does viscosupplementation fit in the treatment spectrum for your patients with mild to moderate knee osteoarthritis?

Clarence Shields: Before considering viscosupplementation, I look to the modifiable factors, such as changing activities, decreasing body weight, and increasing strength, which improves the shock-absorbing ability of the knee joint. These steps give many patients a certain level of symptom relief. Next, I would probably start them on anti-inflammatory medication along with physical therapy. If after a couple of months those steps prove to be insufficient, or if I’d like to provide patients with a greater magnitude of relief, I might recommend viscosupplementation.