Ask the Doctors July 2003 Issue

Ask Dr. Marks: 07/03

I’ve heard recently about “minimally invasive” total hip replacement. How is it done, and what are its advantages—reduced rehab time, a longer lasting replacement?

Surgical techniques have been developed to implant an un-cemented total hip replacement through two small incisions that allow access to the femur and the “cup” or acetabular portion of the hip. The hip prosthesis is fabricated to allow bone to grow into pores or crevasses located on the surfaces of the metal implant. The implant itself is of standard design and can be inserted through a routine open incision or through much smaller incisions used in the minimally invasive technique. An image intensifier is used to help the surgeon accurately place the total hip in the femur and the pelvis. Its main advantage is quicker rehabilitation after surgery. Some patients may return home the day of surgery or the morning after surgery. Its disadvantage is that it is difficult for a surgeon to learn and requires great skill and practice before the technique is mastered. It is not for the occasional ship surgeon. It is not currently applicable for severely deformed arthritic hips. The projected life of the implant is the same as a total hip implanted through a standard surgical approach. As this technique is developed, minimally invasive hip surgery will find and important place in the treatment of osteoarthritis of the hip.

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I recently had my first bout with gout. My doctor prescribed a corticosteroid to relieve the pain but that doesn’t seem to deal with the root of the problem, which I understand is a buildup of uric acid in the joint. Is there any treatment or medication that can help?

Corticosteroids are sometime prescribed to control joint inflammation caused by the deposit of monosodium urate crystals in joints. More commonly, NSAIDs such as Indomethacin are given to treat gout. Gout is caused by an inborn error of metabolism resulting in too much uric acid in the blood, a condition known as hyperuricemia. Approximately 5 percent of the population is hyperuricemic but only a small population will develop gout. Ideally, a person should have only one attack of gout. After the first attack, the medical treatment should reduce the level of plasma uric acid and, by doing so, prevent further attacks. This can be achieved with the medication Allopurinol, which inhibits an enzyme important in the production of uric acid. This drug therapy must be maintained for life. Contrary to what was believed 25 years ago, dietary restrictions are not necessary.

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I’ve read that fish oils reduce arthritis pain—also that topical creams, when mixed with hot pepper extract, dull joint pain. Is there any truth to any of this?

There is some truth in both methods of treating arthritic pain. Fish oils contain Omega-3, which has been shown to exert a modest anti-inflammatory effect on arthritis pain. Omega-3 capsules are usually taken for their cardiovascular protective effect. A more enjoyable way of obtaining the same benefit is to eat dark-meat fish, such as tuna or salmon, two to three times a week. The topical cream that dulls joint pain contains a pepper abstract called Capsaicin. It was first used to treat Shingles. It inhibits substance P, which is a pain transmitter. It must be used two to three times a day. After use, it is important to wash your hands thoroughly, since rubbing the residue in the eyes would cause serious eye irritation.