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Dr. Kathryn Gollotto - 3/2013

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3DPT interviews Dr. Kathryn Gollotto about
Synvisc injections

Dr. GollottoORS

Orthopedic Reconstruction Specialists
600 Somerdale Road, Suite 113
Voorhees, NJ 08043

3DPT: Where are you from and where did you go to medical school?

Dr. Gollotto: I grew up in Ocean City, New Jersey, spoiled by the view of the ocean from my classroom windows. Then I moved on to medical school at the Philadelphia College of Osteopathic Medicine (PCOM) and did my specialty training at Temple University Hospital.

3DPT: What made you go into medicine?

Dr. Gollotto: My passion for medicine stems from two major events in my life. The first being from knee injuries early in high school that landed me on the sidelines. At the time, I was shut down by my orthopedic doctors, but not given any alternative, such as a different form of exercise or physical therapy to treat the underlying biomechanical issue causing my problem. I felt like the doctor's treating me had no understanding of how important sports were to me, which sparked my desire to become a physician that could relate to the athletic population. The good news is that I have been guided into a profession that I love and have resumed activities at a high level.
The second reason for going into medicine is more personal. I spent many years in hospitals with my cousin who passed away from leukemia. It was very difficult to watch her suffer, and I felt helpless. All I could offer her was a hand to hold or a shoulder to lean on, and while I realize now how important that was, at the time it wasn't enough and I wanted to be the person entering the room in the white coat who was offering hope. Much of what I do today is in her memory (but I am not a fan of wearing the white coat so don't expect to see me in one!).

3DPT: Can you please talk about the fluid within a joint, and what happens to that fluid with aging/arthritis?

Dr. Gollotto: A healthy joint contains a small amount of fluid, known as synovial fluid, which is produced by the synovium (the capsule surrounding the joint). Synovial fluid plays an important role in a joint, acting as a lubricant to decrease friction, a shock absorber and a conduit to supply nutrients and remove waste. In the process of arthritis, cartilage loses elasticity and begins to break down, causing changes to the underlying bone, such as bone cysts, bone bruises and bone spurs. Eventually the synovium becomes inflamed, which can either cause excessive fluid to accumulate (known as fluid on the knee) or decreased fluid resulting is inadequate joint protection. In addition, the quality of the synovial fluid is changed. A substance important in shock absorption, know as hyaluronic acid, is decreased in those with arthritis, inflammatory markers known as cytokines begin to infiltrate the fluid which can cause pain, and the joint fluid undergoes "articular gelling" causing the joint to feel stiff.

3DPT: What is Synvisc and how does it work?

Dr. Gollotto: Synvisc is one of several forms of viscosupplement used to treat arthritis and has been FDA approved for treatment of knee arthritis since 1997. Other names that you may have heard include Hyalagan, Euflexxa, Orthovisc, Supartz, Synvisc-One and Gel-One . It is also commonly referred to in the community as the "rooster shot" or "chicken shot" because many of the brands are derived from the comb of a rooster. The basis for the use of this medication is to increase the amount of hyaluronic acid within the joint to provide more lubrication and shock absorption.

3DPT: How is the shot administered and what can the patient expect?

Dr. Gollotto: All of the above medications are given in the office as an intra-articular injection using a small needle. Between 1 and 5 injections are given depending on the medication that is chosen, spaced one week apart. Many people fear the injection because they have heard from others that it is very painful, but when performed correctly and gently, this procedure is very well tolerated. The injection itself is not painful, but feels more like increased pressure within the knee. Occasionally the knee feels stiff and difficult to walk on for 5-10 minutes following the injection, in which case I have have patients relax in the room with a magazine until it feels better. There is typically a mild increase in joint soreness for 1-2 days following the injection, but patients can resume normal activities as tolerated immediately following the procedure, including work and driving. I tend to have my athletes refrain from excessive exercise for the first 24 hours following the injection, but light activity such as biking, walking or the elliptical is okay. The medication is typically very safe and side-effects are rare. The most common adverse reaction, occurring in less than 1% of the population, is what is known as a pseudo-septic reaction, where the joint becomes swollen, red and painful and requires a return to the office to have the fluid removed from the knee. Allergic reactions are reported as rare. In my practice, having performed over 5,000 of these injections, I have seen one case of a pseudo-septic reaction and no cases of allergic reactions.

3DPT: Is it used just in the knees, or are there any other joints where this procedure is performed?

Dr. Gollotto: The use of viscosupplementation for the treatment of arthritis is currently only FDA approved for use in the knee because this is the joint that the majority of studies have been performed in. However, I often use the medication in other joints, such as the hip, shoulder, ankle and hand, with excellent results. There are mounting studies showing the effectiveness of viscosupplementation for decreasing joint pain, improving strength and diminishing disability due to arthritis in these joints. One drawback is difficulty receiving approval from insurance companies and there is often an out of pocket expense for the medication.

3DPT: What are the outcomes with Synvisc for managing joint pain?

Dr. Gollotto: The average patient can expect to notice improvement within 2-4 weeks after the series is completed, however more than 20% of my patients begin to notice improvement even after the first injection. Typically, there is about an 80% reduction in pain, improved mobility and improved stability in the knee. The relief can last anywhere from 6 months to 2 years, with an average of 9 months. Those with less severe arthritis tend to have better longer lasting relief compared to those with more severe arthritis. However, as long as a patient has at least 6 months of adequate pain relief, the injections can be repeated. There are also early studies suggesting that viscosupplement can actually slow the progression of arthritis by stimulating the bodies own production of hyaluronic acid, which is very exciting information because currently the only treatment options we have for arthritis focus on managing the symptoms, but not preventing the disease.

3DPT: What do you like to do in your free time?

Dr. Gollotto: In my free time, I love to stay active! Spending time with my family is first and foremost and this tends to involve outdoor activities and travel. I also feel it is important to give back to your community, so I make every effort to stay involved in volunteer efforts locally, nationally and internationally. And of course, I love to exercise for enjoyment, health, the competitive spirit and the social involvement!

3DPT: Do you ever combine other treatments for arthritis with Synvisc therapy?

Dr. Gollotto: There are many studies that support the use of a combined treatment program for arthritis, which is tailored to the individual. I often continue patients on anti-inflammatory medications as needed for pain. I recommend the use of the vitamin glucosamine, as this has been proven to slow the progression of arthritis and diminish pain. I also encourage patients to stay as active as possible without aggravating their arthritis because movement prevents joint stiffness and weakness. When arthritis pain overcomes someone the stiffness and weakness can set in, as well as altered walking patterns, all of which will eventually lead to unnecessary strain on other areas of the body. When this happens, I often prescribe physical therapy to rebuild strength, improve flexibility, improve stability, improve walking and correct compensatory patterns. Finally, viscosupplement is sometimes used after arthroscopic surgery if there is documented arthritis.

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"The team at 3DPT is made up of dedicated and caring Physical Therapists whose expertise and hands-on approach are what I seek for my patients. It is their fundamental philosophy that has made my professional experiences with them nothing short of exemplary."

     -      Dr. Kathryn Gollotto, DO - Orthopedic Reconstruction Specialists