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Times of India
17 August 2010
By Risha Chitlangia
New Delhi, India

For those suffering from arthritis and osteoarthritis, especially young people, can now postpone their surgery as orthopedists recommend viscosupplementation and corticosteroids to get relief from a painful knee. Experts say that one injection of visco–supplementation can provide relief from knee pain for nearly a year. But doctors have to be careful while choosing between visco–supplementation and corticosteroids.

According to Dr J Maheshwari, senior consultant, orthopedist, Sita Ram Bhartiya Hospital, “Corticosteroids have been there for some time now, but people have a lot of misconceptions about it. Steroids, no doubt, have serious side–effects, but when given locally to a particular area the damage is minimal. The advantage is more than the side–effects.”

Though knee replacement has, of late, become a very common procedure in India, doctors say that a majority of arthritis and osteoarthritis patients are still reluctant to undergo a surgery. “For those who want to postpone the surgery, corticosteroids are an effective solution,” said Dr Maheshwari. With an increasing number of young adults being diagnosed with arthritis and osteoarthritis, doctors say that these injections can help them get rid of the pain to a greater extent. “We recommend these injections to young patients who want to delay or avoid surgery. We have seen that patients, who come to us in the early stages, get 80% relief from joint pain,” said Dr Rajesh Malhotra, professor, orthopaedics and knee replacement, AIIMS.

Doctors say that one should be careful while choosing between corticosteroids and visco–supplementation. “If the joint is dry and painful then visco–supplementation should be given. But in case of fluid retention, corticosteroids are ideal. Visco–supplementation is more effective when there is no other medium available. That is why we don’t give visco–supplementation under local or general anaesthesia,” said Dr Malhotra. But it is the cost factor that forces a lot of patients to opt for corticosteroids. “It (corticosteroids) cost around Rs 800–Rs 1200 whereas one injection of visco–supplementation costs nearly Rs 14,000,” said Dr Maheshwari.

According to Dr P K Dave, head of the department, orthopaedics, Rockland, “Viscosupplementation is more effective and has less side–effects. There are a lot of patients who want to postpone the surgery or don’t qualify for surgery due to underlying health conditions. For them, visco–supplementation is a good solution.”

The biggest advantage of visco–supplementation is that the drug is washed out of the body within four weeks and in that duration it stimulates the knee cells to make fluid (Hyaluronic acid) on its own. “The knee cells starts producing its own lubricant and this helps in keeping the knee flexible and almost pain–free. Corticosteroids just help in reducing the inflammation of the joints,” said Dr Malhotra.

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