X-ray-guided joint fluid therapy is one part of treatment
by: Barbara Sherman READY TO TACKLE OSTEOARTHRITIC KNEES – Dr. Russ Riggs (left) and Dr. Greg Carroll are in a treatment room next to the X-ray equipment that ensures the accuracy of injections of Hyaluronan, a natural substance found in the synovial fluid of the knee.

With the 55-plus communities of Summerfield, King City, The Highlands and others in the area, two doctors have chosen the right location for their particular practice.

Dr. Greg Carroll and Dr. Russ Riggs, who work in emergency medicine, have just opened the Reflex Clinic in the Lincoln Center next to Washington Square where they specialize in diagnosing, treating and relieving knee pain.

Knees are the sole focus of their practice, and what Riggs and Carroll are most excited about is providing a relatively new technique called X-ray-guided joint fluid therapy along with acupuncture, braces and supplements.

The comprehensive knee osteoarthritis treatment program includes a series of three weekly injections of Hyaluronan, a natural substance already found in the synovial fluid of the knee.

It helps to cushion, lubricate and protect knees, and the injections are highly accurate because they are guided by fluoroscopy, which is a type of X-ray.

"Osteoarthritis is a degenerative joint disease," Riggs said. "It can be genetic, due to a prior injury, wear and tear from use, or a tear in the cartilage."

According to Carroll, 50 percent of people at age 65 show X-ray evidence of osteoarthritis, and that number increases to 70 percent by age 70; 70 percent of all people 70 and older will show X-ray evidence of osteoarthritis.

"If you look at the aging population, it's a virtual tidal wave - it's a monster of an epidemic," Carroll added.

Riggs pointed out that generations ago, the average lifespan was around 40 years, and now it is in the 80s.

"Joints were meant to serve for 40 years," he said. "They are programmed to fail after 40 years."

Both Riggs and Carroll admit to being in their 40s, "and we have diagnosed each other with osteoarthritis," said Riggs, 46.

"I started creaking, cracking and crunching," he added. "It affects my hiking."

Both are emergency physicians at Providence Newberg Medical Center.

"We looked at our ER patients with knee problems and looked at the surgical options," Carroll said. "We looked at the literature and found that the least painful procedures worked the best."

They discovered joint fluid therapy replaces the lost synovial fluid - the main fluid in joints - with artificial fluid that uses protein as its main ingredient.

"It's a synthetic substance," Riggs said. "Joint fluid therapy has been used in Europe for about 15 years and in the U.S. for about 11 years.

"We are the first in this area to focus on this. It empowers patients to have choices, and it can be used with other therapies like bracing systems that change the load at the knee. "And there are supplements that patients can take like glucosamine. Not all supplements are created equal - the higher the grade, the better they work."

Toward that end, the clinic sells only the highest-grade supplements available only to physicians.

The clinic also has licensed acupuncturist Naomi Miller on staff.

"We wanted to include acupuncture because it relieves pain, increases function and even prevents the onset," Carroll said.

"And we have an exercise psychologist on staff who will coordinate bracing systems, nutrition and acupuncture as well as help develop an exercise regimen.

"We also want to be collaborative and talk to our patients' primary care doctors."

As for the actual joint fluid therapy, knee joints are very large, according to Riggs.

"We have done all types of knee injections for 12 years in the ER, but this therapy is X-ray-guided, so there is 100 percent accuracy," he said. "Even experienced orthopedic surgeons can miss up to 25 percent of the time when doing injections."

The Reflex Clinic offers a free prescreening program to determine benefits.

"Medicare and most insurance companies pay for these injections," Carroll said. "We feel the patient should know at the front end what their financial investment is going to be."

Riggs pointed out that in the U.S., preventative medical care in not a priority but should be.

"The sooner a person gets in and gets treatment, the better the results," he said.

"And a significant number of people have osteoarthritis but no symptoms yet. It's important to get diagnosed and staged as early as possible."

"Staged" means determining a patient's condition on a level of one to four.

"Stage four is bone-grinding pain, and many of those patients need surgery," Riggs said.

"If someone is at stage two or three, we can keep pushing the need for knee replacement out for years."

Carroll and Riggs want to help their patients avoid knee replacement surgery as long as possible because any surgery has risks, including complications with healing and blood clots. "Knee-replacement is major surgery," Carroll said.

"Everyone with osteoarthritis loves cortisone shots, but they only give relief for three to four weeks," Riggs said.

"With the joint fluid therapy, most patients get relief for six to 12 months."

As far as Riggs and Carroll know, their clinic is the first in the metro area to specialize only in the treatment of knees using X-ray-guided joint fluid therapy.

"Rheumatologists and orthopedic surgeons offer joint fluid therapy, but the injections are not X-ray-guided," Carroll said.

First-time patients get a 90-minute appointment for an initial evaluation and recommended course of treatment.

"A key point for us is letting patients know there are options," Carroll said.

"We are treating the whole patient, we are touching the patient, we are listening to the patient."

Riggs added, "We take a relaxed approach. I would want this for myself. And we are not offering anything that hasn't been thoroughly researched - it's the best treatment out there."

The Reflex Clinic is located at Four Lincoln Center, 10250 S.W. Greenburg Road, Suite 125, Tigard.

For more information, visit or call 503-719-6783.

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