Joan Bateman, myself, and Dr. Khalfayan all agree that surgery should be avoided whenever possible.

Like me, Joan has been diagnosed with osteoarthritis which for her has meant a bum right knee joint.

Osteoarthritis - osteo = bone, arthro = joint, itis = inflammation is a degenerative joint disease which affects healthy synovial fluid and cartilage. Synovial fluid cushions and lubricates against impact where bone meets bone at joints and cartilage, a tough, fibrous tissue at the end of bones, helps prevent friction where bone meets bone at joints.

Osteoarthritis causes synovial fluid and cartilage degeneration which compromises normal joint structure and function resulting in signs of the joint being warm to the touch, red and swollen, with loss of flexibility and mobility as well as symptoms of aching, pain, soreness, and stiffness in the joint even after resting.

Approximately 21 million people in the United States suffer from osteoarthritis, 80 percent of whom are women according to the Center for Disease Control in Atlanta, Ga., and one in four adults in Washington state suffer from this degenerative disease.

To see Bateman go up and down, with alacrity, the steep, multitudinous stone steps leading to and from her garden you would never know that before December of 2007, she had trouble standing let alone walking. The over-the-counter analgesics, anti-inflammatories, herbal medicines and vitamin supplements never relieved the aches and pains or her increasing lack of flexibility and mobility.

"I've been an active person all of my life: skier, gymnast, tennis player, gardener, and doer of elaborate, labor intensive home projects," she says. "I was also one of the few women on a rifle team."

Joan Bateman's unrelieved chronic pain and lack of mobility finally sent her to her primary physician who referred her to Dr. Edward Khalfayan, a prominent specialist in sports medicine and orthopedic surgery with Orthopedic Physician Associates/Proliance Surgeons and clinical instructor in the University of Washington Department of Orthopaedics and Sports Medicine. It was through Dr. Khalfayan that Joan learned about an alternative to knee replacement surgery, Orthovisc.

Orthovisc (High Molecular Weight Hyaluronan) cannot regenerate cartilage, but the hyaluronan in Orthovisc, a substance found in the body's own synovial fluid, does help to replace the loss of synovial fluid needed to cushion, protect, and lubricate joints.

Orthovisc has been used outside the U.S. since the early 90's, and Dr. Khalfayan has been treating osteoarthritis patients in the U.S. with Orthovisc after FDA (Federal Drug Administration) approval, for the past 8 years. As with cortisone injections, it is a non-invasive procedure which involves a series of 3 injections directly into the joint once a week for 3 weeks. Joan Bateman and other patients of Dr. Khalfayan who have had the Orthovisc injections notice improvement within 3 to 6 weeks, and Dr. Khalfayan quoted to me a 70 percent success rate in the relief of pain and increased mobility.

Orthovisc is not a cure-all, and it is not indicated for people with Rheumatoid Arthritis or other autoimmune, degenerative, joint diseases. Orthovisc treatments are also contra-indicated for people with allergies to poultry products or people with infections.

Khalfayan says that most people like Bateman, will inevitably need a knee replacement. Even with the technological advancements in medical devices, instruments, and implants there are always dangers inherent in undergoing surgery. There is also the recovery time after surgery and physical therapy to help ensure the maximum in joint flexibility.

"There are so many advantages to the Orthovisc injections," said Khalfayan. "They not only delay surgery; they decrease the need for pain medications and anti-inflammatories which can cause gastro-intestinal bleeding in many people as well as kidney damage, and unlike cortisone injections Orthovisc injections can be repeated without causing damage to joint tissue."

I asked Khalfayan if there were any preventive measures people could take to avoid osteoarthritis.

"People see me because they are already experiencing the pain and lack of mobility associated with osteoarthritis ... by the time people see me the only thing I can do is recommend measures such as weight loss and low impact flexibility exercises as well as the medical treatments open to them ... there is so much variability in the people I see: people in their early 20s to middle-age, people who have suffered previous injuries to the affected joints, and people who have a genetic propensity for joint disease."

Bateman and I have also had other joints affected by osteoarthritis. Khalfayan believes that the U.S. Food and Drug Administration will soon approve Orthovisc treatments for other than just knee joints affected by osteoarthritis.

At the end of my phone interview with Khalfayan we laughed when I reminded him that, as with Joan Bateman, he had treated me for osteoarthritis years ago which required a surgical repair of a medial meniscus on my right knee. Now with signs and symptoms in my other joints, as with Ms. Bateman, I might be seeing Dr. Khalfayan in the near future, not for surgery this time, but for Orthovisc injections.

Maureen Kearney is a registered nurse and a freelance writer in West Seattle and may be reached via wseditor@robinsonnews.com