Category Archives: Bones, Joints & Muscles

How much does a new hip cost? Even the surgeon doesn’t know

surgeons performing surgery in operating roomBy Jenny Gold

What will a gallon of milk set you back? How about a new car? You probably have a rough idea.

But what about a medical device — the kind that gets implanted during a knee or hip replacement? Chances are you have no clue. And you are not alone: The surgeons who implant those devices probably don’t know either, a just-published survey shows. Continue reading

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Does knowing medical prices save money? California experiment says yes

Hip replacement  - thumbBy Ankita Rao

The fact that the cost of a hip replacement can ring up as $15,000 or $100,000 — depending on the hospital — makes a lot of people uncomfortable. But that’s only if they know about the wide price tag variations.

In an effort to raise awareness and rein in what can seem like the Wild West of health care, the California Public Employees’ Retirement System (CalPERS), the second largest benefits program in the country, and Anthem Blue Cross started a “reference pricing” initiative in 2011.

The initiative involved a system to guide their enrollees to choose facilities where routine hip and knee replacement procedures cost less than $30,000.

Here’s how it works: The CalPERS program designated certain hospitals that met this cost threshold, and enrollees who chose among these facilities pay only the plan’s typical deductible and coinsurance up to the out-of-pocket maximum.

Patients who opted for other in-network hospitals were responsible for regular cost sharing and “all allowed amounts exceeding the $30,000 threshold, which are not subject to an out-of-pocket maximum,” noted the report.

The results tallied savings of $2.8 million for CalPERS, and $300,000 in patients’ cost sharing, according to research released Thursday by the Center for Studying Health System Change for the non-profit group National Institute for Health Care Reform.

Researchers found that patients who received “intensive communication” from CalPERS were supportive of the efforts and recognized lack of price transparency in the system. The report also said enrollees were satisfied with the level of care they received when choosing facilities that met their cost threshold.

But that information has yet to reach the larger population of health consumers, said Alwyn Casill, the director of public relations for the Center for Studying Health System Change.

“There is a tremendous need to increase public awareness of this problem,” she said. “It should matter to you as someone who is paying for health care, not just for you, but for everybody.”

While the report doesn’t completely detail CalPERS’ approach to reference pricing, Casill said there is optimism that it will be a model for other insurance plans and medical systems.

But that is further limited by the narrow focus of this initiative on just two kinds of procedures — others, like MRIs and CAT scans, are also vulnerable to wide pricing disparities.

Some experts say any real success on streamlining health care costs will include the ability for consumers to understand the issue and call for change.

“The numbers are dramatic,” said Julie Schoenman, director of research and quality at the National Institute For Health Care Management Foundation, a non-profit educational organization unaffiliated with the report. “I think you really do need to have good quality measures, good transparency. And a lot of patient education.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Women’s Health – Week 6: Bone Health and Osteoporosis

From the Office of Research on Women’s Health

Bones are living tissue. A healthy body with strong bones is essential to overall health and quality of life. Strong bones support us and protect the heart, lungs, brain, and other organs from injury. Weak bones break easily. They cause pain and interrupt everyday activities.

Osteoporosis, or porous bone, is a disease characterized by low bone mass. It makes bones weak and more likely to break – especially the bones of the hip, spine, and wrist.

The disease is a major public health threat for an estimated 44 million Americans, 68 percent of whom are women. Every year, 1.5 million Americans suffer a fracture because of weak bones, mostly in the wrists, spine, and hips.

Osteoporosis is called a silent disease because bone loss occurs without symptoms. People typically do not know that they have osteoporosis until their bones become so weak that a sudden strain, twist, or fall results in a fracture (broken bone). Many people are unaware of the link between a broken bone and osteoporosis.

While white women over the age of 50 are at highest risk for osteoporosis, women and men of every age and ethnicity should be concerned about bone health.

If you are older than 65, have broken a bone after age 50, have relatives with a broken bone, have certain medical conditions (for example, hyperthyroidism or arthritis), or take certain prescription medications (such as thyroid medicine or glucocorticoids), you may be at higher risk for osteoporosis. Talk to your health care provider and find out if you need a bone density test.

osteoporosis

Diagram showing a healthy spine versus a spine showing signs of osteoporosis. Click on the image to view larger.

Some steps you can take to help prevent osteoporosis and fractures:

  • Be physically active every day to keep your bones strong. Weight-bearing physical activity causes new bone tissue to form, which makes bones stronger.
  • Eat a healthy diet, including calcium and vitamin D, which are critical for good bone health.
  • Know that smoking and heavy alcohol use reduce your bone mass and increase your risk for broken bones.
  • Reduce your risk of falling with physical activity to make you stronger and to improve your balance and coordination (making you less likely to fall).
  • Make your home safe by removing things you can trip over (like small rugs and stepstools), using non-slip mats in the bathtub and shower, and installing bright light bulbs to make it easier to see.
  • Ask a health care provider to review your prescription and over-the-counter medicine because some medicines, or combinations of medicines, can make you less alert, slower to react, and can lead to a fall.
for more information: www.niams.nih.gov
NIH and You
Milk matters is a public health education campaign that promotes calcium consumption among tweens and teens, especially between the ages of 11 to 15, a time of critical bone growth. Bones grow fastest during the tween and teen years, and adequate calcium intake during these years helps prevent osteoporosis later in life. But, studies show that most tweens and teens are not getting enough of it in their diets. Fewer than one in ten girls and only one in four boys ages 9 to 13 are at or above their adequate intake of calcium. Although the consequences of low calcium consumption may not be visible in childhood, the Eunice Kennedy Shriver National Institute of Child Health and Human Development recognizes lack of calcium during the critical years of bone development can have a serious effect on the health of young people later in life.

 
for more information: www.nichd.nih.gov/milk

 

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Women’s health week 5 – Autoimmune disorders

From the Office of Research on Women’s Health

The immune system is a network of your body’s cells, tissues, and organs that works to defend the body against attacks by dangerous microscopic organisms,  such as bacteria,  parasites, fungi, and viruses that can cause infections.

For example,  when you cut yourself,  bacteria enter into your body through the cut. Your immune system immediately goes into action,  using a variety of cells to find and destroy the danger.

Similarly, when you are first exposed to a virus, your immune system mounts an attack and in the process develops a memory of the virus so that if you are exposed for a second time, your immune system is able to begin the fight against the virus faster. Your immune system works to keep you healthy.

The key to a healthy immune system is its remarkable ability to distinguish between your own body,  which it tolerates and keeps safe, and infectious organisms, which are dangerous and it attacks.

But sometimes, for reasons we do not yet fully understand, the immune system breaks down and mistakenly attacks the body’s own organs, tissues, and cells. When your immune system attacks your healthy body,  you develop an autoimmune disease. Genes,  or heredity, seem to play an important role. Today, we know of more than 80 human autoimmune diseases, many of them rare.

Symptoms of autoimmune disorders vary widely and depend on the disease. Symptoms often include dizziness, fatigue, a general ill feeling, and a low-grade fever. Your health care provider can diagnose autoimmune disorders through a physical exam. He or she also will ask you about your symptoms and family history, and will likely conduct laboratory tests.

These are some of the more common autoimmune disorders:

Lupus,  also known as Systemic Lupus Erythematosus,  occurs when your immune system attacks healthy cells and tissues by mistake. This can damage your joints,  skin,  blood vessels,  and organs. Lupus affects more women than men, and is more common in African American, Hispanic, Asian, and Native American women. Symptoms include joint pain or swelling, muscle pain,  fever with no known cause,  and red rashes,  often on the face (also called the butterfly rash).

Rheumatoid Arthritis is not like osteoarthritis,  which only affects your joints and bones. Rheumatoid arthritis affects joints and bones (often of the hands and feet),  and may also affect your skin and other organs. Rheumatoid arthritis generally occurs in a symmetrical pattern,  meaning that if one knee or hand is involved,  the other one is also involved. People with rheumatoid arthritis may have flare-ups,  which means that the pain and inflammation from the arthritis may appear to come and go suddenly. If you have rheumatoid arthritis,  you may also feel sick or tired,  and have a fever. Rheumatoid arthritis occurs more often in women than men.

thyroid graves disease exophthalmos

A diagram showing the tyroid gland and exophthalmos (bulging eyes) as a result of Grave’s disease.

Grave’s Disease is a disease of the thyroid gland (located in the front part of the neck below the larynx,  or voice box). Your thyroid controls how quickly your body uses energy. If you have Grave’s disease,  you have an overactive thyroid. Symptoms of an overactive thyroid include insomnia,  irritability,  weight loss,  sensitivity to heat,  fine brittle hair,  bulging eyes,  and shaky hands. Grave’s disease is treated with radioactive iodine,  medication,  and sometimes surgery. Grave’s disease is more common in women and those under the age of 40.

Sjögren’s Syndrome is a disease that causes dryness in the eyes and mouth. It can also lead to dryness in other normally moist areas such as the nose,  throat,  and skin. Sjögren’s syndrome is more common in women and those over the age of 40.

Most autoimmune disorders are chronic (long-term) diseases that can be controlled by treating the symptoms. For some,  symptoms come and go,  and flare ups can occur. Autoimmune disorders are serious conditions and should not be taken lightly. If you are having symptoms,  talk with your health care provider.

If you are diagnosed with an autoimmune disorder,  your health care provider will work with you to decrease your symptoms and control the autoimmune process while maintaining your body’s ability to fight disease. Treatments vary according to the disease and symptoms and there is still no known way to prevent most autoimmune disorders.

For more information:  www.niaid.nih.gov,  www.niams.nih.gov,  and www.niddk.nih.gov
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Women’s health: Week 4 – Arthritis

From the NIH Office of Research on Women’s Health

tacuin womenArthritis is a chronic (long-term) disease. The word arthritis means joint inflammation. Inflammation is a response of body tissues to injury or irritation.

Arthritis can affect joints in any part of your body and may cause pain, stiffness, and swelling in the joints and in areas close to the joints.

The most common form of arthritis is osteoarthritis. Health care providers sometimes call osteoarthritis a degenerative joint disease. It is related to age and most often affects the fingers,  knees,  and hips.

Osteoarthritis occurs when your cartilage,  the tissue that cushions the ends of the bones within the joints,  breaks down and wears away. In some cases, all of the cartilage may wear away, leaving bones that rub up against each other.

Osteoarthritis can follow an injury to a joint, even many years later. For example, a young person might badly hurt her knee playing soccer. Years after her knee has apparently healed,  she can develop arthritis in her knee.

Osteoarthritis is more common for:

  • Women after age 45.
  • People who are overweight.
  • People with jobs that put stress on particular joints.

You might have some form of arthritis if you have some of these symptoms:

  • Lasting joint pain.
  • Joint swelling.
  • Joint stiffness.
  • Tenderness or pain when touching a joint.
  • Problems using or moving a joint.
  • Warmth and redness in a joint.

If you experience these symptoms,  talk to your health care provider about a management plan for your specific needs. Health care providers can use several methods to diagnose and rule out other problems. If you have the condition,  treatment options include:

Osteoarthritis arthritis

A diagram showing the eroded cartilage in an osteoarthritic knee.

  • Exercise:  Daily exercise,  such as walking or swimming, helps keep joints moving, lessens pain, and makes muscles around the joints stronger. Three types of exercise are best if you have arthritis:
    1. Range-of-motion exercises,  like dancing,  relieve stiffness,  keep you flexible,  and help you move your joints.
    2. Strengthening exercises,  such as weight training, will help improve muscle strength. Strong muscles support and protect your joints.
    3. Aerobic or endurance exercises,  like bicycle riding,  make your heart and arteries healthier,  help prevent weight gain,  and improve the overall working of your body. Aerobic exercise may also lessen swelling in some joints.
  • Weight control:  Weight loss can lessen stress on your weight-bearing joints,  limit future injury,  increase your ability to move around,  and lessen the need for medications.
  • Rest and relief from stress on joints:  It is important that you learn to recognize your body’s signals,  and know when to stop or slow down. This will help to prevent pain caused by being too active.
  • Non-drug pain relief:  If you have osteoarthritis,  you may find medication-free ways to relieve pain including:
    • Applying heat or cold (or a combination of the two) can be useful for joint pain.
    • Getting a massage where a massage therapist lightly strokes and/or kneads the painful muscles. This increases blood flow and brings warmth to a stressed,  inflamed area.
  • Medications to control pain:  Health care providers prescribe medicines to get rid of or lessen the pain and to improve your ability to function.
  • Surgery:  For many people,  surgery helps relieve the pain and disability of osteoarthritis.

Another form of arthritis is called rheumatoid arthritis, which is an autoimmune disorder.

For more information,  please see Week 5.

for more information:  www.niams.nih.gov
Complementary and alternative therapies
People with arthritis often try various complementary and alternative therapies. Some people have found pain relief using acupuncture. Others have also tried folk remedies such as wearing copper bracelets,  drinking herbal teas,  and taking mud baths. Nutritional supplements such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis,  as have certain vitamins. While these practices may or may not be harmful,  no scientific research to date shows that they are helpful in treating osteoarthritis.

for more information:  http://nccam.nih.gov

 

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FDA Updates Safety Recommendations for Metal-on-Metal Hip Implants

An FDA Consumer Update

The US Food and Drug Administration has updated its safety information and recommendations to patients and health care professionals based on the agency’s current assessment of metal-on-metal hip implants, including:

  • the benefits and risks
  • the evaluation of published literature
  • the results of an FDA advisory panel meeting held in June 2012

Risk:

Implant components slide against each other during walking or running, which releases tiny metal particles. These particles may damage bone or soft tissue surrounding the implant and joint. Soft tissue damage could lead to pain, implant loosening, device failure and the need for revision surgery.

Some of the metal ions released will enter the bloodstream and travel to other parts of the body, where they may cause discomfort or illnesses.

Recommendations for People Considering a Metal-on-Metal Hip Implant

  • Be aware that every hip implant has benefits and risks.
  • Discuss your options for hip surgery with your orthopedic surgeon.

Recommendations for People With Metal-on-Metal Hip Implants

  • If you are not having any symptoms and your orthopedic surgeon believes your implant is functioning properly, continue to follow-up routinely with the surgeon every one to two years.
  • If you develop new or worsening problems, such as pain, swelling, numbness, noise (popping, grinding, clicking or squeaking of your hip) or a change in your ability to walk, contact your orthopedic surgeon right away.
  • If you experience changes in your general health, including new or worsening symptoms outside your hip, let your doctor or other health care professional know you have a metal-on-metal hip implant.

For More Information

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Osteoarthritis – from NIH MedlinePlus magazine

From NIH MedlinePlus magazine 

What Is Osteoarthritis?

Osteoarthritis is the most common type of arthritis. People usually have joint pain and stiffness. Unlike rheumatoid arthritis, it does not affect skin tissue, the lungs, eyes, or blood vessels.

In osteoarthritis, cartilage—the hard, slippery tissue that protects the ends of bones where they meet to form a joint—wears away. The bones rub together, causing pain, swelling, and loss of motion. Over time, the joint also may lose its normal shape. Bone spurs—small deposits of bone—may grow on the edges of the joint. Also, bits of bone or cartilage can break off inside, causing more pain and damage.

Where does osteoarthritis occur?

Hands—Osteoarthritis of the hands seems to run in families. Women are more likely than men to have hand involvement. For most, it develops after menopause. Small, bony knobs may appear on the end joints (those closest to the nails) of the fingers. Fingers can become enlarged and gnarled, and may ache or be stiff and numb. The base of the thumb joint also is commonly affected.

Knees—Symptoms include stiffness, swelling, and pain. This makes it hard to walk, climb, and get in and out of chairs and bathtubs.

Hips—There is pain and stiffness of the joint itself. But sometimes pain is felt in the groin, inner thigh, buttocks, or even the knees. Osteoarthritis of the hip may limit moving and bending. This can make dressing or other daily activities a challenge.

Spine—There is stiffness and pain in the neck or lower back. In some cases, arthritis-related changes in the spine can put pressure on the nerves where they exit the spinal column. This results in weakness, tingling, or numbness of the arms and legs. In severe cases, bladder and bowel function can be affected.

Osteoarthritis Basics: The Joint and Its Parts

Joints allow movement between the bones and absorb the shock from walking or other repetitive motion. Joints are made up of:

Cartilage. A hard, slippery coating on the end of each bone.

Joint capsule. A tough membrane that encloses all the bones and other joint parts.

Synovium (sin-O-vee-um). A thin membrane inside the joint capsule that secretes synovial fluid.

Synovial fluid. A fluid that lubricates the joint and keeps the cartilage smooth and healthy.

Ligaments, tendons, and muscles. Tissues that surround the bones and joints, a llowing the joints to bend and move. Ligaments are tough, cord-like tissues that connect one bone to another. Tendons are tough fibers that connect muscles to bones. Muscles are bundles of specialized cells that, when stimulated by nerves, either relax or contract to produce movement.

A Healthy Joint

Illustration: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Illustration: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

In a healthy joint, the ends of bones are encased in smooth cartilage. Together, they are protected by a joint capsule lined with a synovial membrane that produces synovial fluid. The capsule and fluid protect the cartilage, muscles, and connective tissues.

A  Joint With Severe Arthritis

A Joint With Severe Osteoarthritis. Illustration: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

A Joint With Severe Osteoarthritis.
Illustration: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

With osteoarthritis, the cartilage wears away. Spurs grow out from the edge of the bone, and synovial fluid increases. The joint feels stiff and sore.

Fast Facts

  • Osteoarthritis is the most common type of arthritis. More common in older people, it is sometimes called degenerative joint disease.
  • Osteoarthritis most often occurs in the hands (at the ends of the fingers and thumbs), spine (neck and lower back), knees, and hips.
  • Some 27 million Americans age 25 and older have osteoarthritis.
  • Osteoarthritis is more likely in overweight people and among those with jobs that stress particular joints.
  • Exercise is one of the best treatments for osteoarthritis.
  • Before age 45, osteoarthritis is more common in men. After 45, it is more common in women.

Warning Signs of Osteoarthritis

  • Pain and stiffness in a joint after getting out of bed or sitting for long.
  • Swelling in one or more joints, especially those at the ends of the fingers (closest to the nail), thumbs, neck, lower back, knees, and hips.
  • Crunching feeling or the sound of bone rubbing on bone
  • Osteoarthritis may progress quickly, but in most people it develops gradually. It is relatively mild and interferes little with daily life in some people. Others have significant pain and disability.
  • If you feel hot or your skin turns red, or if your joint pain is accompanied by a rash, fevers, or other symptoms, you probably do not have osteoarthritis. Check with your health provider about possible other causes, such as rheumatoid arthritis.

Diagnosis

A combination of the following methods are used to diagnose osteoarthritis:

Clinical history—You will be asked when the condition started and how your symptoms have changed since. You will also describe any other medical problems you or your family may have, and any medications being taken. This helps your doctor make a diagnosis and understand the disease’s impact on you.

Physical examination—Your doctor checks your strength, reflexes, and general health. She or he also examines bothersome joints and observes your ability to walk, bend, and carry out daily activities, such as dressing.

X rays—X-rays will help determine the form of arthritis and how much damage there is, including cartilage loss, bone damage, and bone spurs.

Magnetic resonance imaging —Magnetic resonance imaging (MRI) provides high-resolution computerized images of internal body tissues. It is used if there is pain, X-rays don’t show much, or there is damage to other joint tissues.

Other tests—Your doctor may order blood tests to rule out other causes of symptoms. Fluid may also be drawn from the joint for microscopic examination to determine whether the pain is from a bacterial infection or uric acid crystals, indicating gout.

Treatment

Doctors often combine treatments to fit a patient’s needs, lifestyle, and health. Osteoarthritis treatment has four main goals: Improve joint function, keep a healthy body weight, control pain, and achieve a healthy lifestyle. Treatment plans can involve:

Exercise—Research shows that exercise can improve mood and outlook, decrease pain, increase flexibility, strengthen the heart and improve blood flow, maintain weight, and promote general physical fitness. Your doctor and/or physical therapist can recommend the exercises best for you.

Weight control—Weight loss can reduce stress on weight-bearing joints, limit further injury, and increase mobility. A healthy diet and regular exercise help reduce weight. A dietitian can help you develop healthy eating habits.

Rest and relief from stress on joints—Learn to recognize the body’s signals, and know when to stop or slow down. Regularly scheduled rest prevents pain from overexertion. Proper sleep is important for managing arthritis pain. If you have trouble sleeping, relaxation techniques, stress reduction, and biofeedback can help.

Nondrug pain relief and alternative therapies—You may find relief from:

  • Heat or cold (or a combination of both). Heat—with warm towels, hot packs, or warm bath or shower—can increase blood flow and ease pain and stiffness. Cold packs (bags of ice or frozen vegetables wrapped in a towel) can reduce inflammation, relieving pain or soreness.
  • Massage uses light stroking and/or kneading of the muscles to increase blood flow and warm the stressed joint.
  • Complementary and alternative therapies—Some people have found relief from such therapies as acupuncture. A large study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Center for Complementary and Alternative Medicine (NCCAM) showed that acupuncture can relieve pain and improve function in knee osteoarthritis.
  • Nutritional supplements—such as glucosamine and chondroitin sulfate have been reported to improve osteoarthritis symptoms in some people.

Medications

When selecting medicines, your doctor will consider the intensity of pain, potential side effects of the medication, your medical history, and other medications you are taking. By working together, you and she or he can find the medication that best relieves your pain with the least risk of side effects.

The following medicines are commonly used to treat osteoarthritis:

Acetaminophen—A common over-the-counter pain reliever. It is often the first choice for osteoarthritis patients because of its safety and effectiveness compared to some other drugs.

NSAIDs (non-steroidal anti-inflammatory drugs)—A large class of medications for both pain and inflammation. It includes aspirin, ibuprofen, naproxen, and others. Some NSAIDs are available over the counter, while more than a dozen others are available only with a prescription. NSAIDs can have significant side effects. Anyone taking NSAIDs regularly should be monitored by a doctor.

Narcotic or central acting agents—Mild narcotic painkillers containing codeine or hydrocodone are often effective against osteoarthritis pain. But because of their potential for physical and psychological dependence, they are generally for short-term use.

Corticosteroids—Powerful anti-inflammatory hormones that may be injected into the affected joints for temporary relief. No more than four treatments per year are recommended.

Hyaluronic acid substitutes—These medications are injected to help lubricate and nourish joints. They are approved only for osteoarthritis of the knee.

Other medications—Doctors also may prescribe topical pain-relieving creams, rubs, and sprays, which are applied directly to the skin over painful joints. Because most medicines used to treat osteoarthritis have side effects, it is important to learn as much as possible about the medications you take, even the ones available without a prescription.

Surgery

For many people, surgery helps relieve the pain and disability of osteoarthritis. You may have surgery to:

  • remove loose pieces of bone and cartilage (arthroscopy)
  • reposition bones (osteotomy)
  • resurface bones (joint resurfacing).

Surgeons also may replace affected joints with artificial ones called prostheses. These can last up to 15 years or longer. The surgeon chooses the prosthesis according to the patient’s weight, sex, age, activity level, and other medical conditions.

After surgery and rehabilitation, the patient typically feels less pain and moves more easily.

No pills, yet . . .

“There are no pills yet for osteoarthritis, but we’re working on it . . . “

“There are no pills yet for osteoarthritis, but we’re working on it,” says Linda Sandell, Ph.D., professor of Orthopaedic Surgery and of Cell Biology at the Washington University School of Medicine, in St. Louis. In osteoarthritis, the soft tissue called cartilage, which cushions the knees and other joints of the body, wears away, causing pain and loss of mobility.

“It’s a huge and growing public health issue,” says Sandell, who points out that more than 50 percent of people age 65 and over have osteoarthritis. “But it is not just a disease of old age; people get it when they’re young, too.”

Under a multi-year grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), she and her colleagues are studying stem cells in specially bred mice to determine whether there is a correlation between injury and healing.

“Every person has stem cells, and some people are better at repairing than others,” Sandell observes. “We need to find the gene, or genes, for cartilage repair and osteoarthritis in these mice, and target these genes in the development of medications that could be used in humans.

“Every person has stem cells, and some people are better at repairing than others.”

“But like heart disease or obesity, osteoarthritis is a complex disease; the research is difficult and expensive, and improvements are hard to measure. We need to change its image as an inevitable result of old age. It has a molecular start, and it takes a long time to develop. People often don’t realize that their joints are degenerating until late in the process when they begin to hurt.”

Sandell says people can’t change their age but they can reduce the risks of osteoarthritis, which, in addition to genetics, include prior joint injuries and being overweight, through exercise and a healthy diet. “First,” she urges, “no more couch potato. Check with your doctor, then start walking a couple of miles a day. Use—but don’t overuse—your joints.

“Pay attention to what your body is telling you. If your cartilage is okay but your knee is inflamed, ice it,” she advises. “Keeping fit is one of the keys to delaying arthritis.”

Ongoing research

Osteoarthritis is not simply “wear and tear” in joints as people get older.

Researchers are studying:

  • Tools to detect osteoarthritis earlier
  • Genes
  • Tissue engineering—special ways to grow cartilage to replace damaged cartilage
  • Medicines to prevent, slow, or reverse joint damage
  • Complementary and alternative therapies
  • Vitamins and other supplements
  • Education to help people better manage their osteoarthritis
  • Exercise and weight loss to improve mobility and decrease pain
  • Researchers are learning about sex differences that explain why women are more susceptible than men to anterior cruciate ligament (ACL) injuries, which can lead to osteoarthritis. These include structural differences of the knee joint and thigh muscles and differences in the ways male and female athletes move. They are also developing ways to protect young female athletes from these injuries.
  • Discovery of the various genetic mutations leading to osteoarthritis could lead to new treatments.
  • Longer-lasting materials and designs that more closely mimic natural knee movement are making total joint replacements more suitable for younger, more active osteoarthritis patients.
  • Despite the benefits, African American and Asian American patients are less likely than their white counterparts to choose total knee replacement. Also, researchers have found that race is more important than socioeconomic status in these decisions. That is an important first step toward improving access to knee surgery, and to help all patients make informed decisions about their treatment.
  • Surgical advances have made hip replacements safer for older patients. This helps older patients who have other conditions that previously would not have allowed them to have the procedure.
  • Less invasive surgical approaches and preoperative exercise programs have led to decreased hospital stays and faster recovery. If adopted nationwide, they could lead to major cost savings.

Articles in NIH MedlinePlus magazine are written by professional journalists. All scientific and medical information is reviewed for accuracy by representatives of the National Institutes of Health. However, personal decisions regarding health, finance, exercise, and other matters should be made only after consultation with the reader’s physician or professional advisor. Opinions expressed herein are not necessarily those of the National Library of Medicine. Photos and other images without credit lines are provided by NIH.

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Need a price for a hip replacement? Good luck with that . . .

Hip replacement  - thumbBy Scott Hensley, NPR News
This story comes from our partner ‘s Shots blog.

Let’s say your 62-year-old granny is feeling creaky. One of her hips has been giving her trouble, and her doctor tells her it’s time to get it replaced with an implant.

There’s a catch. Grandma isn’t old enough for Medicare and she doesn’t have health insurance. She does, however, have a stack of cash in the bank and is willing to pay for surgery right away.

So how much will it cost her?

Who knows. Seriously.

Researchers from Iowa called 20 top-rated orthopedic hospitals across the country using a script based on Grandma’s predicament. They asked for the lowest price (everything included) for a total hip replacement.

The researchers also asked two other hospitals in each state and Washington, D.C., for good measure.

Getting an answer wasn’t easy.

Of the top 20 hospitals, only 9, or 45 percent, provided a bundled price that included fees for both the doctors and the facilities.

But that response looks terrific compared with how the other hospitals did.

The researchers were able to get a bundled price estimate from only 10, or about 10 percent, of the other 102 hospitals they queried.

The researchers were able to piece together prices in quite a few instances by contacting doctor groups when hospitals provided only their fees.

Even after incorporating those figures, however, total pricing information was available for only 60 percent of the top hospitals and 63 percent of the others.

The prices obtained varied widely: from a low of $11,100 to more than $125,000.

The findings were just published online by JAMA Internal Medicine.

Why couldn’t more hospitals comply? Some said a doctor would need to see a patient before an estimate could be given. Others said they didn’t give out prices over the phone. Some just said there was no way they could do it.

“Our calls to hospitals were often greeted by uncertainty and confusion by the hospital representatives about how to assist us,” the researchers wrote. “It is sobering to compare our experience with the best practices we have come to expect from other service industries.”

Buying a car used to be like this, an accompanying editorial points out: “A 2013 hip replacement looks a lot like a 1954 Buick.” But a 1958 federal law that required dealers to post sticker prices on vehicles began a long road to fuller disclosure about prices and specifications that have changed the marketplace for automobiles.

Now it’s time for hospitals and doctors to do a better job, the authors of the editorial write. “There is no justification for the inability to report a fee estimate, or a 12-fold price variation for a common elective procedure,” they declare.

As a matter of fact, they argue, the health care business is even worse off than the car business was. Many doctors and hospitals don’t know the price of their products, unlike car dealers.

Still, there’s hope, the editorialists say.

“The history of the automobile industry shows that information asymmetry is treatable,” they write. “Health care will need to travel down a similar path. It is time we stop forcing people to buy health care services blindfolded — and then blame them for not seeing.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Vertebrae

Evidence does not back-up spinal manipulation for acute lower back pain

By Joan Vos MacDonald, Contributing Writer
Health Behavior News Service

Manipulating or “adjusting” the spine is a popular way to treat occasional or acute lower back pain and is covered by many health insurance plans, but a recent review by The Cochrane Library finds no evidence to suggest it is more effective than other therapy options.

According to the National Institutes of Health, lower back pain affects eight out of 10 people, and is commonly caused by injury or overuse.

Spinal manipulation (SMT), a technique used by chiropractors, osteopaths, naturopaths and some medical doctors, is used to improve the range of motion of the joints in the spine.

“SMT is a worldwide, extensively practiced intervention; however, its effectiveness for acute lower back pain is not without dispute,” said lead reviewer Sidney Rubinstein, senior researcher at the VU University Medical Center in Amsterdam.

Key Points:

  • Acute lower back pain, defined as pain lasting six weeks or less, resolves on its own in most cases.
  • Spinal manipulation, often used by chiropractors and osteopaths, is no more effective than exercise, NSAIDs or other physical therapy to treat acute lower back pain.

The reviewers studied the results from 20 randomized controlled trials representing 2,674 participants with lower back pain of less than six weeks duration.

Reviewers concluded that SMT neither reduced pain nor sped recovery faster than treatment options such as exercise, the use of NSAID pain medications or physiotherapy.

Surprisingly, the review also found no evidence to suggest that SMT was more effective than therapies known to be ineffective.

“This last finding would suggest more research is needed,” said Dr. Rubinstein. If SMT is just as effective as accepted interventions, it should be better than ineffective therapies, such as using ultrasound or heat therapy.

“Such reviews may be confusing because they are not comparing apples to apples,” said Mitchell Freedman, D.O., director of Physical Medicine and Rehabilitation at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia. “For a start, there are different kinds of manipulation, some more aggressive and some limited to stretching. Also, while spinal manipulation is not useful in all circumstances, it can be in some. You do need to look across a whole spectrum.”

Another complicating factor is the nature of acute lower back pain. Defined as lasting six weeks or less, it tends to go away on its own in almost 90 percent of all cases.“Studies do promote the use of manipulation in subacute to chronic pain which is different from acute pain,” said Freedman.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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Group Health Icon

Group Health study finds “shared decision making” may reduce medical procedures

Osteoarthritis of the knee

By Ankita Rao

While policymakers debate whether doctors should be paid by the number of services they provide or the outcomes of their treatment, shared decision could have an impact on the ground by reducing demand for medical procedures.

A new Health Affairs report about decision aids, materials given to patients to help educate them about treatment options, shows that they can help hold down costs.

“The decision aids discuss all the available treatment options equally,” said Dr. David Arterburn, an author of the study released Tuesday and investigator at Group Health Cooperative, a non-profit health system in Seattle

For example, in the aids for joint disorders, he said, “Losing weight and increasing physical activity are discussed in detail, as are anti-inflammatory medications, other over the counter medications, and prescription medications for treating osteoarthritis.”

Decision aids can be used for a variety of medical issues, from cardiovascular health to hip replacements. They are delivered in the form of DVDs or printed guides, and are usually provided before a patient visits a specialist.

Researchers conducted randomized trials in Washington state with patients who suffered from knee and hip osteoarthritis, the most common joint disorders in the U.S. They sent aids to 332 patients with hip osteoarthritis and 978 to patients with knee osteoarthritis. The treatments and outcomes were then tracked and compared to a control group that did not receive the aids.

After six months, researchers found that among patients with knee problems who received aids, 38 percent fewer chose to have elective knee replacement surgery than the control group.

Among patients with hip problems, 26 percent fewer opted for hip replacement surgery.

Patients who received aids also had slightly fewer visits to primary care and specialty care doctors.

Overall treatment costs were lower among patients who received aids. For those with hip osteoarthritis, the average total cost of treatment was $13,489 after the use of decision aids, compared to $16,557 for the control group. In the knee osteoarthritis groups those with aids spent $8,041 compared to $10,040 in the control group.

Many states see promise in the shared decision model, and are taking early steps to encourage its use.  Minnesota, for example, outlines the need for a physician to discuss health care options in a shared decision making process in its rules for medical homes.

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X-ray of a broken hip

Avoid broken bones: Learn about low bone density

X-ray of a broken hip

Broken hip

By Carolyn M. Clancy, M.D.
Director, Agency for Health Care Research and Quality

Until you or a loved one has broken a wrist or hip, it’s easy to downplay the risks that come with low bone density. But these risks are serious, and the consequences can cause big life changes.

Low bone density occurs when our bodies lose bone tissue faster than it can be replaced. It is a major cause of broken bones, especially at the spine, hip, and wrist.

People with low bone density have either osteopenia, a mild form of this condition, or osteoporosis, a more severe type.

Low bone density affects about 52 million Americans, both men and women. Osteoporosis is more common in women who have gone through menopause.

An estimated 1 in 5 U.S. women over age 50 has osteoporosis. Ten percent of these women have osteoporosis of the hip, according to the Centers for Disease Control and Prevention.

While a broken bone is not a major concern when we’re young, it is a serious health issue as we get older.

A broken hip, for example, usually requires surgery, takes a long time to heal, and can require that a person need ongoing care.

Fortunately, some of these problems can be prevented. Today, more treatments are available to help reduce the risk of breaking a bone and to build new bone tissue faster. They include medicines, nutritional supplements, and exercise.

To help understand your options, a new consumer summary from the Agency for Healthcare Research and Quality’s Effective Health Care Program describes the latest research findings on these treatments.

It also helps you think about the kinds of questions to ask your doctor about a diagnosis of low bone density.

The summary covers:

  • Medicines: Researchers looked at five types of drugs for women with osteoporosis who have gone through menopause. They “graded” each medicine based on whether it reduced the risk of breaking a bone in the wrist, spine or hip, or whether the evidence is still unknown. Possible side effects of the medicines are also listed, along with additional information about how to deal with these side effects.
  • Nutritional supplements: Taking calcium and Vitamin D on its own or with prescription medicines may reduce the risk of developing osteoporosis. However, researchers are not sure if taking calcium or Vitamin D reduces the risk of breaking a bone in people who already have osteoporosis. The summary lists foods that are high in calcium and Vitamin D.
  • Exercise: Your doctor may recommend exercise as a way to strengthen bones, improve balance, and reduce the risk of falling. In particular, weight-bearing exercises like walking, lifting weights, and climbing stairs help make bones stronger.
  • Making a Decision: There are several factors to keep in mind as you decide which treatment is right for you. These include:
    • Your risk for breaking a bone, based on results of a bone density test.
    • Whether you need to start taking medicine now or if you can wait.
    • The benefits and side effects of different medicines, your out-of-pocket costs for each option, and whether you can take a generic version.

A chart in the summary lists the wholesale prices of osteoporosis medicines, brand names, and price per month for a generic version. Your cost will depend on your health insurance, how much medicine you need, and whether the medicine comes in a generic form.

A new online decision aid called “Healthy Bones” was developed as part of this summary for women who have gone through menopause.

It helps you calculate the risk of breaking a bone, gives detailed information about medicines to prevent a break, and lets you print information and questions to take to your doctor.

People used to think that the effects of low bone density couldn’t be prevented. Today, we’re learning that we have good treatment options that can lower risks and improve health outcomes.

But for the best results, it’s up to us to get educated about our choices and find the one that best fits our needs.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Reducing the Risk of Bone Fracture: A Review of the Research for Adults with Lone Bone Density
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=1049

Effective Health Care Program
http://www.effectivehealthcare.ahrq.gov/index.cfm

Healthy Bones: About Osteoporosis
http://www.effectivehealthcare.ahrq.gov/ehc/decisionaids/osteoporosis/

Centers for Disease Control and Prevention
FastStats: Osteoporosis 
http://www.cdc.gov/nchs/fastats/osteoporosis.htm

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Hip replacement  - thumb

How does the FDA monitor your medical implants? It doesn’t, really.

by Lena Groeger
ProPublica

Each prescription drug you take has a unique code that the government can use to track problems. But artificial hips and pacemakers? They are implanted without identification, along with many other medical devices.

In fact, the FDA doesn’t know how many devices are implanted into patients each year – it simply doesn’t track that data.

The past decade has seen numerous high profile cases of malfunctioning medical devices, which have led to injury or even death. Critics say the FDA’s minimal monitoring of devices contributes to these problems.

“If you’re lucky, you might find a sticker on the operating room note that was left over from the product,” said Richard Platt, who runs the Harvard Pilgrim Health Care Institute. Otherwise, there is little way of knowing what device was used.

Right now, the FDA depends mostly on voluntary reports from doctors, patients, manufacturers and hospitals to notify them of problems with devices already on the market.

The agency does have some power to require manufacturers to conduct further studies or track a particular device once it is sold. But many devices don’t get that level of surveillance.

“It’s much like a patchwork of streams of information getting to the FDA,” said cardiologist Frederic Resnic of Brigham and Women’s Hospital, who has worked with the FDA on medical device safety monitoring. “The FDA is relying on anecdotal and very variable information about the safety of medical devices.”

If manufacturers get word from a doctor or hospital about a death or injury that occurred as a result of their product, they are legally obligated to investigate the event and report it to the FDA.

But the process isn’t straightforward, as has become clear in the recent controversy over the malfunctioning St. Jude’s Riata defibrillator leadsb(wires that connect a defibrillator to the heart). The FDA said an individual doctor’s report helped alert them to the problem, but it was months before the device was recalled.

“What you would normally consider the simplest kind of data analysis is not done.”

According to attorney William Vodra, a regulatory law expert and member of the Institute of Medicine panel that published a report on medical device safety last year, the number of doctors who actually contact manufacturers is small.

And after being notified of patient harm, manufacturers can minimize their own responsibility if they point the blame elsewhere, said health policy expert Diana Zuckerman, president of the National Research Center for Women & Families.

For example, if someone dies from complications in a surgery to remove an implant, the manufacturer may argue that it was the surgery – not the implant – that killed the patient.

“While the FDA has made significant progress on tracking drugs, it’s not yet in a position to do the same thing for devices“

You have a system that is not rigorous, the standards are not always understood, and they are interpreted differently by different people,” Zuckerman said.

The FDA responds to the criticism by pointing out that while every medical device carries a potential risk, the vast majority of devices perform well and improve patient health.

An FDA spokeswoman emphasized that the agency must evaluate thousands of medical devices each year, and is constantly looking for ways to better and more quickly identify problems.

While the FDA makes the adverse event reports publically available in a searchable database, it doesn’t have a standardized system for reviewing reports once they are sent in, said Vodra, the attorney.

A disclaimer on the site specifically states that the data is “not intended to be used either to evaluate rates of adverse events or to compare adverse event occurrence rates across devices.”

“What you would normally consider the simplest kind of data analysis is not done,” said Zuckerman. Often, doctors catch a malfunctioning device before the FDA ever notices.

In one case, a group of Pennsylvania doctors noticed that several patients were showing severe complications a few years after getting an IVC filter – a device designed to capture blood clots.

Bits of the filter were breaking off, causing chest pain and a dangerous build-up of fluid and pressure around the heart.

In 2010 the doctors conducted their own study and found that the filter broke in a quarter of all patients who used it.

On the day that study was published, the FDA issued a warning saying it had received over 900 reports of problems with IVC filters since 2006, and that the device was meant to be removed after a few months, not left in permanently.

There have been numerous attempts at reform. Five years ago Congress ordered the FDA to set up a post-market surveillance system to track the safety of all medical projects, but a system hasn’t yet been set up for medical devices.

A year later the FDA announced the Sentinel Initiative, which would combine existing data from electronic health records and medical claims to track drugs, vaccines, and devices.

Some groups of hospitals or other organizations have voluntarily set up registries to collect information about the make and model of devices.

While the FDA has made significant progress on tracking drugs, it’s not yet in a position to do the same thing for devices, according to Harvard’s Platt, who is the principal investigator of Mini-Sentinel, the FDA’s pilot program for the national system. The data isn’t there.

The FDA has long acknowledged the need for a unique device identifier system, and got permission from Congress to set one up five years ago.

No such system of ID-tags exists yet, but after several recent high profile medical device failures, the issue getting some attention from Congress.

A proposed Senate bill, which cleared the Health, Education, Labor and Pensions Committee last week, sets a timeframe for implementing a unique identification system, among other reforms.

“If UDI’s were used in a consistent way, we could use the same kinds of techniques we’ve developed for drugs for devices,” said Platt. “It would be a huge breakthrough.”

 

Want to know more? Follow ProPublica on Facebook and Twitter, and get ProPublica headlines delivered by e-mail every day.

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X-ray of a broken hip

How often should women have bone tests?

By Vicki ContieX-ray of a broken hip
NIH Research Matters 

Experts recommend that older women have regular bone density tests to screen for osteoporosis. But it’s been unclear how often to repeat the tests.

A study of nearly 5,000 women now reports that patients with healthy bone density on their first test might safely wait 15 years before getting rescreened.

Osteoporosis is a disorder marked by weakened bones and an increased risk of fractures. More than 40 million people nationwide either have osteoporosis or are at increased risk for broken bones because of low bone mineral density (osteopenia).

Osteoporosis is often called a “silent disease” because it usually progresses slowly and without symptoms until a fracture occurs.

When low bone density is identified early through screening, lifestyle changes and therapies can help protect bone health and reduce the risk of fractures.

That’s why the U.S. Preventive Services Task Force recommends routine screening of bone mineral density for women ages 65 and older.

To help doctors decide how often to repeat bone density tests in women who don’t have osteoporosis at their initial screening, a research team led by Dr. Margaret Gourlay of the University of North Carolina at Chapel Hill analyzed data on nearly 5,000 women, age 67 or older.

The women were participants in the Study of Osteoporotic Fractures, a long-term nationwide study supported by NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institute on Aging (NIA) and National Center for Research Resources (NCRR).

Researchers divided the women divided into 4 groups based on initial bone density tests that were either normal or showed mild, moderate or advanced osteopenia. They were given 2 to 5 bone density tests at varying intervals during the 15-year study period.

As reported in the January 19, 2012, issue of the New England Journal of Medicine, the scientists found that less than 1% of women who initially had normal bone mineral density went on to develop osteoporosis during the study.

Only 5% of those with mildly low bone density at the start made the transition to osteoporosis. Overall, the data suggest that women in these 2 categories might safely wait about 15 years before being rescreened for osteoporosis.

The scientists also found that about 1 in 10 women with moderate osteopenia at baseline developed osteoporosis within 5 years. For those with advanced osteopenia at the start, about 10% had developed osteoporosis within a year, suggesting that 1-year screening intervals might be advisable for this group.

“If a woman’s bone density at age 67 is very good, then she doesn’t need to be rescreened in 2 years or 3 years, because we’re not likely to see much change,” Gourlay says. “Our study found it would take about 15 years for 10% of women in the highest bone density ranges to develop osteoporosis. That was longer than we expected, and it’s great news for this group of women.”

These findings can help guide doctors in their bone screening recommendations. Other risk factors, such age, medications or specific diseases, would also influence screening frequency.

This article first appeared in NIH Research Matters.

To learn more about osteoporosis:

 

 

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MRI of the knee

Baby boomers trigger jump in knee replacement surgeries


MRI of the knee

Credit: Wikipedia - Creative Commons License

By Carolyn M. Clancy, M.D.

January 3, 2012

Whether it’s music, lifestyles, or a refuse-to-age outlook, Baby Boomers think of themselves as trailblazers.

Now, that generation born between 1946 and 1964 can claim credit for another “first”—a dramatic increase in knee replacement surgeries.

Women and men between the ages of 45 and 64 were more than twice as likely to have had knee replacement surgery in 2009 than in 1997, recent data from the Agency for Healthcare Research and Quality (AHRQ) show. The rates among women were even higher.

Knee replacement surgery is most common in people whose knees have been damaged by osteoarthritis (OA), rheumatoid arthritis, or injury.

Due to their age and fondness for sports, Baby Boomers fit neatly into each category.

The percentage of people who have osteoarthritis, the most common type of arthritis, grows with age. About 27 million Americans have this condition, and, after age 45, it is more common in women. Osteoarthritis occurs when the cartilage that coats the end of each bone breaks down. This can cause the bones to rub against each other, causing pain and stiffness.

Knee pain may also be caused by rheumatoid arthritis, a less common form of arthritis that occurs when the membrane surrounding the joint becomes inflamed. Over time, inflammation damages cartilage, resulting in pain and stiffness. Rheumatoid arthritis affects about 1.3 million people—more women than men. It often begins in middle age, but can occur in children and young adults.

Arthritis after a serious knee injury or repeated stress is another reason for knee replacement surgery. Pain caused by ligament tears or bone fractures caused by sports injuries, for example, may be managed non-surgically for years. Over time, however, pain and limited knee function causes some patients to consider knee replacement surgery.

If you have knee pain from one of these causes, you’ve probably heard about treatments that are intended to relieve pain and even postpone the need for surgery. Some, but not all, of these options work, a review of 86 research reports funded by AHRQ has found.

What has been shown to work?

  • Exercise. Becoming more active—whether through walking, swimming, or water aerobics—can reduce pain and make movement easier. Physical therapy may also help, so ask your doctor if you would benefit.
  • Maintain a healthy weight. A 10 percent weight loss combined with a moderate exercise program reduced knee pain in patients with knee osteoarthritis by 50 percent, a recent study  by Wake Forest University researchers has found.
  • Pain medicines. Medicines can relieve osteoarthritis pain, AHRQ’s research review concluded. Your doctor or nurse may prescribe an over-the-counter or prescription medicine. Learn more about choosing pain medications for osteoarthritis in this guide developed by AHRQ.

What has been shown not to work?

  • Glucosamine and chondroitin. Some people take nutritional supplements to help build new cartilage. Studies have found that people who take these supplements report less pain, but people who don’t take the supplements report the same result.
  • Joint lubrication shots. This treatment is a gel-like substance given by a shot into the knee. Studies have found that most people who get the shots do not improve very much.
  • Arthroscopic knee surgery. In this procedure, a flexible tool is inserted into the knee, which is used to rinse the joint. It can be helpful for other types of knee problems, but not for knee osteoarthritis.

If conservative treatments don’t provide relief from pain, it may be time to consider knee replacement surgery. The good news is that this procedure has been shown to give a better quality of life that makes it worth the cost, a Government-funded study has found.

The benefits of this procedure are even better if the surgery is done at a hospital that does a large number of knee replacement procedures.

Before you have surgery, prepare yourself for the best possible outcome by asking questions of your surgeon. You will feel more in control of your health if you have a good idea of what to expect before, during, and after surgery.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Healthcare Cost and Utilization Project

Statistics on Hospital-Based Care in the U.S., 2009
http://www.hcup-us.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp

Effective Health Care Program

Osteoarthritis of the Knee: A Guide for Adults
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=132

Choosing Pain Medicine for Osteoarthritis
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageAction=displayProduct&productID=4

Having Surgery? What You Need to Know
http://www.ahrq.gov/consumer/surgery/surgery.htm

National Institute of Arthritis and Musculoskeletal and Skin Disease

Handout on Health: Osteoarthritis
http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp

Handout on Health: Rheumatoid Arthritis
http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp

Total Knee Replacement Found Cost-Effective for End-Stage Knee OA
http://www.niams.nih.gov/News_and_Events/Spotlight_on_Research/2009/knee_OA_replacement.asp

American College of Rheumatology

Weight Loss Best Medicine for People with Knee Osteoarthritis
http://www.rheumatology.org/about/newsroom/2011/2011_ASM_21_weightloss.asp

Current as of January 2012


Internet Citation:

Baby Boomers Trigger Major Increase in Knee Replacement Surgeries. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, January 3, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc010312.htm

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Yoga

Yoga no better than stretching for back pain, Group Health study finds

Yoga and stretching classes are equally effective in treating moderate back pain, according to a study from Seattle’s Group Health Research institute published online today by the journal Archives of Internal Medicine.

In a smaller, earlier trial, lead author Dr. Karen Sherman, Ph.D. and colleagues found that yoga was slightly more effective than a program of aerobic, strengthening, and stretching exercises, so they decided to do a larger trial in which patients with back pain were randomly assigned to participate in a yoga program, a stretching program or to self-care.

The yoga and stretching programs consisted of 12 weekly, 75 minute classes at Group Health facilities. In addition, participants were asked to practice for 20 minutes a day on non-class days.

To supplement class instruction, the participants received handouts and instructional yoga CDs or stretching DVDs.

The yoga program included seven simple postures adopted from a style of yoga called viniyoga. Each class included breathing exercises, 45-50 minutes of yoga, and ended with a session of “guided deep relaxation,” the researchers write.

“We expected back pain to ease more with yoga that with stretching, so our findings surprised us.”

The stretching class included 10 strengthening exercises and 15 stretching exercises for a total of 52 minutes of stretching.

The self-care group received The Back Pain Helpbook, which provides information about the causes of back pain, advice on exercising, lifestyle modifications and the management of flare ups.

At the end of 12 weeks, back-related symptoms and function had improved in all three groups, but those in the stretching and yoga programs saw significantly more improvement than those in the self-care group.

“We expected back pain to ease more with yoga than with stretching, so our findings surprised us,” said Dr. Sherman.

“The most straightforward interpretation of our findings would be that yoga’s benefits on back function and symptoms were largely physical, due to the stretching and strengthening of muscles,” Dr. Sherman said.

Dr. Sherman speculated that because the stretching classes included more stretching than many programs and because the stretches were held for a relatively long time, the stretching classes may have “been a bit more like yoga than a more typical exercise program would be.”

“Our results suggest that both yoga and stretching can be good, safe options for people who are willing to try physical activity to relieve their moderate low back pain,” Dr. Sherman said. “But it’s important for the classes to be therapeutically oriented, geared for beginners, and taught by instructors who can modify postures for participants’ individual physical limitations.”

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