A 60 year old patient with a history of osteoarthritis is experiencing worsening knee pain. Which option would you discuss with him?

• A. Intra-articular viscosupplementation
• B. Topical NSAIDs
• C. High dose oral Motrin
• D. Urgent total knee arthroplasty

Answer: (A)

In the context of a 60-year-old patient with worsening knee pain due to osteoarthritis, the discussion of intra-articular viscosupplementation is particularly relevant. This treatment involves the injection of hyaluronic acid or similar substances into the knee joint to help restore the normal viscosity and elasticity of the synovial fluid, offering lubrication and cushioning within the joint.

The rationale for considering viscosupplementation lies in its goal of alleviating pain and improving function for patients with osteoarthritis, which is characterized by the degeneration of joint cartilage and underlying bone. This can lead to decreased synovial fluid quality and quantity, contributing to pain and disability. By providing additional fluid to the joint space, viscosupplementation can help reduce friction, enhance joint mobility, and subsequently improve the patient's quality of life.

Unlike other options such as topical NSAIDs, high-dose oral Motrin, or urgent total knee arthroplasty, viscosupplementation is less invasive and can be a suitable intermediate treatment before considering surgical options. It allows for a tailored approach to managing osteoarthritis, especially for patients looking to avoid more invasive procedures. This makes it an important option in the discussion of treatment for this patient.