By: Peter A. Caprise, Jr., MD
As the largest multidisciplinary, musculoskeletal clinic in the Commonwealth, OrthoVirginia
(OVA) is committed to being a leader in the development of new and innovative treatments in the Sports Medicine
field. One current area of research involves osteoarthritis of the hip in the middle-aged athlete.
Osteoarthritis is the gradual wearing away of the cartilage that covers the end of the bones that make up the joint, and the loss of the viscosity of the lubricant called synovial fluid. As the cartilage breaks down and the lubricating fluid becomes less viscous, an athlete will notice an increase of achy type pain at the beginning of exercise or perhaps afterward for a period of time. This will eventually increase to pain that limits or effects the quality of the athletic performance.
At OVA, the treatment for osteoarthritis in the middle-aged athlete is tailored to the patient’s symptoms, physical exam and goals. Broadly speaking, oral medications (NSAIDs and Tylenol), activity modification/physical therapy, and occasionally a steroid injection into the joint are the first traditional steps. These work by modifying the pain through both chemical (medications and injection) and mechanical (physical therapy) pathways.
An additional and more controversial mechanical treatment is the injection of a supplement or gel called hyaluronic acid into the joint to increase the synovial fluid viscosity. The logic is by increasing the thickness and slickness of the joint fluid that the irregular surfaces move with more smoothly and thus creates less pain. There are multiple products on the market such as Synvisc, Orthovisc or Euflexxa but the FDA has only approved them for use in the knee. This lack of approval means that we cannot offer it as a treatment option for those athletes with mild to moderate osteoarthritis of the hip.
It is hopeful this will change soon. At the Lynchburg
office of OrthoVirginia, we are one of a handful of sites across the nation approved for the FDA study of the efficacy of Monovisc, a synthetic hyaluronic acid, in the hip. This is randomized, double blind study comparing the Monovisc to a placebo. This rigorous type of research is needed to determine if Monovisc is an appropriate treatment for the athlete with mild to moderate arthritic symptoms, and demonstrates OVA’s commitment to its athletes. If you are interested in participating in the study, please contact April Page at OVA at 434-485-8500.
About the Author:
Dr. Peter Caprise is an orthopaedic surgeon and practices out of our Lynchburg location. He received his medical degree from University of North Carolina at Chapel Hill School of Medicine and has been in practice for more than 20 years.