Joan Bateman isn't ashamed to describe her figure. "I'm on the portly side," she said. "That's the truth."But the 64-year-old Boeing retiree was ashamed that she used to have trouble walking. Arthritis had crippled the cartilage in her knees. Moving down the stairs to her garden was difficult - activities like skiing and hiking were impossible.More than one in 10 Americans age 64 or older suffers from osteoarthritis of the knee. Arthritis-related conditions cost more than $81 billion (or $1,752 per person) in direct medical costs in the United States each year, with indirect costs and other expenses reaching nearly $47 billion, according to the American Medical Association. In 2001, people with osteoarthritis of the knee made more than 5.5 million visits to physicians' offices and more than 271,000 outpatient visits, according to the American Academy of Orthopaedic Surgeons. For Ann Welton, 57, an elementary school librarian, the prospect of replacing her arthritic knee, along with the surgery's lengthy recovery period, was too much."[A doctor] told me I needed a knee replacement, and I didn't really want that," she said. "So I went in for a second opinion. That's when I found Dr. Khalfayan." PAIN-RELIEVING INJECTIONSDr. Edward Khalfayan is a Seattle-based surgeon and specialist in sports medicine and arthroscopic surgery who has worked at the University of Washington. He's also a team physician for the Seattle Seahawks and the medical director for the Seattle Mariners. Both Bateman and Welton sought his advice about knee replacement."The surgery does have its risks," Khalfayan said. "If the new knee only lasts 20 years, that means they'll have to put in another one eventually, especially if it's a young person. And a total knee replacement is also a really expensive proposition." Some doctors, like Khalfayan, estimate that the cost for total knee replacement, depending on the insurance company, can reach up to $50,000 for the implant, procedure and various hospital bills. One alternative that Khalfayan and other local surgeons recommend is viscosupplements, a family of pain-relieving injections that can help patients put off surgery for several years. "That's the goal of this kind of procedure," he said. "It's not going to keep people from getting a knee replacement in the long run, and it's not going to help everybody. But some 70 percent of people respond really well to it."DIFFERING MEDICAL OPINIONSThe Food and Drug Administration has approved the use of viscosupplements only for treatment of the knee, but its use in other joints is currently undergoing clinical testing. Still, the success rate of the procedure has been a beacon of controversy among many orthopaedic specialists. "A lot of us were really enthusiastic about [viscosupplements] when they came out," said Dr. Seth Leopold, an associate professor at the University of Washington and vice chair of the UW Department of Orthopaedics and Sports Medicine. "But since then, the reception in some of the peer-reviewed literature about it has been lukewarm. In my own experience, it's not much more effective than a $5 cortisone shot." Cortisone, a steroid injection used as an anti-inflammatory pain reliever, typically works for two to four weeks. But according to Khalfayan, some viscosupplements, like Orthovisc, can give patients relief for up to 12 months. Other local experts agree with the use of viscosupplements, saying that the negative effects of cortisone outweigh its positives."I tend to use [cortisone] less," said Dr. James D. Bruckner, an orthopaedic surgeon and knee specialist for Proliance Orthopaedics and Sports Medicine in Bellevue and the University of Washington Bone and Joint Center. "It is cheaper. But its benefits are also only temporary. When a patient takes Orthovisc, their improvements tend to be much longer lived than through steroid injections." Khalfayan also argued that steroid injections like cortisone could actually worsen the condition of joints. "If you take too many anti-inflammatory drugs like Advil or cortisone in the long term," Khalfayan said, "it could have some negative effects. Your blood pressure could increase, or it could lead to ulcers. And if those ulcers start bleeding, you have to go to the emergency room."ALSO FOR ATHLETESKhalfayan said Orthovisc is also useful for treating athletes. Players from the Mariners and Seahawks have successfully undergone the procedure, he said."Lots of younger people could benefit from it," he said. "If it didn't work I wouldn't be using it. And it's not just me; it's sports teams and physicians all across the country."Khalfayan also stressed that viscosupplements like Orthovisc aren't for everyone, that "some people should just go and get the total knee replacement."But for aging baby boomers like Bateman and Welton, the treatment was a resounding success. Welton said she can "finally run across the street" if she needs to. And for Bateman, it's still a matter of moving up and down the stairs to her garden. Only now, she sprints. "You should see it," she said. "I feel like I'm 45 years old again."[[In-content Ad]]
