Intra Articular Joint Program

What is the Intra Articular Joint Program?

An estimated 21 million Americans have Osteo-Arthritis [OA]  and it is the leading cause of work disability in the US . Research has demonstrated that musculoskeletal conditions, including OA, cost the US economy between $95-149 billion/year including direct and indirect costs.

Because the knee supports almost all of one’s body weight, this joint is highly susceptible to injury and progressive degeneration over time. If you suffer one or more of the following symptoms in your knee(s), you may have OA:

  • Aches and pains, especially with motion
  • Stiffness, especially in the morning and when standing up
  • “Grating”, “grinding” or “catching” sensations or sounds emanating from the knee when rising from sitting or climbing stairs.
  • Limited motion
  • Redness and swelling

Above:  normal knee, severe oa knee, and knee x ray

When you have OA of the knee:

  • The joint fluid may lose its ability to provide nutrients and lubrication to protect the joint.
  • Smooth cartilage that normally protects the ends of the knee bones may lose its cushioning effect or become pitted and frayed. Large areas of cartilage may even wear away completely, so the bones scrape painfully over each other.
  • Cartilage breakdown may cause the joint to lose its shape, and the bone ends may thicken and form bony spurs.
  • Fragments of bone or cartilage may float in the joint space, causing further damage and pain.

Our Intra Articular Joint Program [IAJP] has evolved as a result of extensive literature review and clinical experience in the treatment of knee pain due to OA. Osteoarthritis is an advanced stage of an active and progressive disease process that leads to joint degeneration and deformation, loss of cartilage, and loss of proper functioning.

If you experience any of the above and would like to schedule an examination and evaluation please call us at 516-599-3999.


1. Viscosupplementation with Hyalgan
2. Real-time fluoroscopic guidance
3. Specialized Rehabilitation Program.
4. Comprehensive multidisciplinary approach

Our IAJP combines viscosupplementation [see below] using Hyalgan [hyperlink to Hyalgan exp] performed under real-time fluoroscopic guidance [hyperlink to fluoroscope with picture] with a specialized rehabilitation program based on a unique and specific algorithm, created to enhance strength and mobility of the knee.


Viscosupplementation is the process of injecting sodium hyaluronate [in this case Hyalgan®] directly into the affected knee joint(s). It has been studied for treatment of osteoarthritis for more than 40years, first in Europe and later in the United States.  Hyaluronic acid is a natural component of synovial fluid that lubricates joints, provides cushioning, and supports the cartilage surfaces of the joint. It reduces pain, swelling , and inflammation.

The anology we use is that it is like WD-40® and the Joint Compound used to fill holes in sheetrock walls. It lubricates, fills gaps, and smoothes surfaces. Osteoarthritis of the knee cannot be cured but the pain can be controlled, and the joint and it’s surrounding tissues an be rehabilitated.


Hyalgan contains a natural substance called hyaluronate that is normally found in the fluid that lubricates and cushions the knee joint.  With OA the smooth cartilage on the surface of the bone gradually wears away, the joint fluid thins, and the joint fluid loses its lubricating and cushioning ability.  This results in progressive degeneration of the knee joint and causes pain, joint stiffness and dysfunction. Hyalgan viscosupplementation treatments relieve pain and can be safely repeated. Hyalgan knee injections were approved by the FDA in May of 1997, and has proved to be a safe and effective way to treat osteoarthritis of the knee. More than 25 million Hyalgan injections have been given worldwide. For more information visit


Intra articular injections are widely used in clinical practice, but their effect is variable and their value remains doubtful  which may be due to inaccurate placement. Our injections are performed under real-time fluoroscopic guidance.  This enables us to see exactly where the Hyalgan is being placed.

FluoroscopeFluoroscopy is a type of x-ray that uses a continuous or pulsed beam of low-dose radiation to produce continuous real time images of a joint or body part at rest or in motion.  The fluoroscope is focused on the area of interest and the images are captured as pictures or are sent to a monitor for viewing.  A contrast medium may be used to visualize the joint space and highlight the images. This way we can see exactly where the Hyalgan is placed.


Our doctor of physical therapy has created a unique structured rehabilitation program which is an integral part of our Intra-Articular Joint Program [IAJP] for treatment of osteoarthritis of the knee(s). Numerous scientific research studies have confirmed the therapeutic benefits of combining guided  viscosupplementation injections with physical therapy and knee rehabilitation.  The literature and treatment guidelines also support the benefits of utilizing acupuncture and orthotic devices when necessary for treatment of the dysfunction and symptoms commonly associated with osteoarthritis of the knee(s).


Malverne Health & Rehabilitation is truely a multidisciplinary facility. Our medical staff, doctor of physical therapy, doctor of chiropractic, acupuncturist, and massage therapists are all committed to doing whatever we can to relieve your pain, improve your overall functioning, and optomize your treatment outcomes.  To schedule an examination and evaluation please call us at 516-599-3999.



What is the Intra Articular Joint Program?

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