Supplements: Does the Truth Really Matter?

Apparently Not!

Today - a brief blog entry. This is because a fact is a fact. Here are two facts.

1. All the glucosamine, chondroitin sulfate, MSM, joint pills, etc that you are taking are helping only one person- the person who owns the company that sells you this nonsense. Stop it now. Maybe one day, solid research will lead us to solutions in this important area of neutraceuticals but this is not that day.

I am sure that herbal medicine and nutrition is an untapped resource of tremendous help to all arthritis sufferers but what is on the market - all of it - is a waste of your money and a waste of shelf space on pharmacy stores. Just don't buy it. Just don't use it. Demand that good research is performed.

2. The joint viscosupplementation injections- hyaluronic acid which is marketed under multiple names (Synvisc, Hyalgan, Orthovisc, Euflexxa) does help some patients but not as many as whoever is injecting you is probably claiming.

If your arthritis is bone-on-bone then the injections are totally worthless. Some doctors effectively run "injection clinics". They should be shut down. Some give it and within 6 months do a knee replacement - this is a money making scam.

Don't get me wrong - there are clear "responders" to this treatment. There is extraordinarily important work in this area. Again - we are not at the day where the "joint grease" solution is anything close to a solution. In early arthritis there is probably a role. The real studies (ones not supported by industry) are sketchy on this. Just be careful about the doctors who inject people in a line that looks like new marine recruits getting their hair cut.

...more later

Dr. K.
BTW- I expect there may be just a few comments here- bring 'em on.

Related Topics: Exercise Good for Early Knee Osteoarthritis, Manage Your Osteoarthritis

Technorati Tags: glucosamine, arthritis, arthritis injections

Pain After Knee Replacement

From The Message Board

Knee Replacement

I'm going march 30th to get my left knee replaced, can any one tell me what to expect ((((pain wise))))


Pain After Knee Replacement

No one can really predict from what patient to the next what to expect concerning pain. It is sort of like dental work. For me, dental work is so painful I feel I need general anesthesia for a teeth cleaning, other people can have their teeth drill from here to China and swer to me that they have no pain.

The topic of pain relief after any form of knee surgery, whether is it a total knee replacement of a partial knee resurfacing or partial knee replacement has three components to it:

1. The extent of the surgery
2. The perception of the patient
3. The methods used by the surgeon to control your pain

The Extent of the Surgery

In the first 2-3 weeks after surgery, there is no question that some form of minimally invasive surgery is less painful. This probably has more to do with the length of the incision plus the actual type of procedure performed.

While it is now well known that the results of standard vs. minimally invasive surgery are exactly the same 3 months after the surgery the early going is clearly better in minimally invasive procedures. There can be a trade-off though. Many minimally invasive hip replacement procedures like the heavily advertised 2-incision approach by Zimmer have a significantly higher complication rate than single incision MIS approaches advocated by most respected joint surgeons.

The complications seen in the increasingly less popular 2-incision approach has been dislocations, failure to put the component in properly and joint stiffness. This approach should simply be abandoned.

In knee replacement I like to look at the minimally invasive approaches in two categories. The first is limited incision total knee replacements. This is, in reality, not a true minimally invasive procedure. The reason is that in the end you are left with a total knee replacement- a lot of metal. Nothing very minimally invasive about putting heavy metal in the joint. If you need a total knee replacement - fine. Then using a limited incision or a more minimally invasive approach offers some pain relief and short-term rehabilitation advantages.

A true minimally invasive knee replacement is a partial knee resurfacing which is more commonly called a partial knee replacement or a unicompartmental knee replacement. This is true MIS knee surgery in that the ligaments of the knee are left completely intact vs. a total knee replacement where these important ligaments are hacked out (or surgically removed- semantics...)

While in my practice over 65% of knee replacement patient turn out to be xcellent and appropriate candidates for partial knee resurfacing that is not the case across the country. The decision to offer a patient this tuely less painful and higher functioning surgery is often dependent upon surgeon training and philosophy. For example, just south of me at a little known island called Manhattan, very few MIS resurfacing procedures are performed. On the other hand, if you were to be seen in the Washington, DC area, Boston, Bufallo, or Tampa you will be more appropriately given the option for this procedure.

The reason is this: One is the old adage- "When your only tool is a hammer, everything looks like a nail."

If a surgeon only performs total knee replacements, which is a salvage type procedure, then of course, that is the only procedure that surgeon would recommend. I have had many patient over the years who saw me for MIS, less painful knee resurfacing, and saw a second or third opinion with either a surgeon across the county from me or a surgeon in Manhattan. The patient has invariably called me and said, Sr. X said a knee resurfacing is not the right procedure. I asked the patient to return to that surgeon and ask him or her how many knee resurfacing they performed in their lives. I always know the answer so when the patient calls me back and says that the surgeon they went to never performed a partial knee resurfacing then it is clear that a reasnble infomermed choice was not given to the patient. As I perform total and partial knee resurfacing, as I believe all surgeons should have in their armamentarium, then the patient gets a balanced opinion.

Partial knee resurfacing is probably 10 times less painful, 6 times faster rehabilitation, and has a remarkably lower complication rate and higher level of function.

Based on this, you can see how the actual surgery chosen contributes to your pain after knee replacement.

NEXT POSTING:
The use of Multiple Methods of Pain Control to Achieve Success...

Dr. K.

Related Topics: Why Your Hips Are A Pain in the Butt, Is Less-Invasive Hip Replacement For You?

Technorati Tags: partial knee replacement, unicompartmental, knee pain