Ask the Doctors November 2005 Issue

Ask the Doctors: 11/05

Iím 42 and have arthritis in both knees. My doctor tells me Iím too young for a knee replacement, so Iím considering having a high-tibial osteotomy. What are the advantages and disadvantages of this surgery?

Arthritis is often more severe on one side of the knee than the other, and typically the condition is worse on the medial (inside) part of the knee. This can cause malalignment of the leg into a varus, or bowlegged, position, which places increased stress on the arthritic portion of the joint. In a high-tibial osteotomy (HTO), a wedge of bone is removed from just below the knee joint so that the leg can be aligned into a better position to correct alignment of the knee. This relieves pressure on the arthritic portion of the joint and transfers it to an area of more normal cartilage.

The primary advantage of an HTO is that it can delay the necessity of knee replacement for several years by reducing pain and improving function. The major disadvantage is that it is not a permanent fix, and a total knee replacement will eventually be required.†

HTO is a major surgical procedure, with all of the attendant risks, and it does require a period of recuperation and rehabilitation of six to eight weeks or more.

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Iíve read that lumbar spinal stenosis is a common problem in older people. What is it, and how is it treated?

Lumbar spinal stenosis is a narrowing of the spinal canal that occurs with age; often it is associated with arthritis. As the spinal canal narrows, it compresses the nerves that run through it, which can cause back pain, leg pain, and leg weakness.

Spinal stenosis does not always cause symptoms. Generally, patients with spinal stenosis are comfortable if they are sitting but have more pain down their legs when they walk (the pain increases with more walking). Walking while leaning over a supporting object (such as a walker or shopping cart) can help ease the pain, and sitting decreases the pain.

Nonsurgical treatments may include changes in posture, anti-inflammatory medications, weight loss, use of a lumbar brace or corset, and epidural steroid injections. Physical therapy can help stabilize the spine, build endurance, and increase flexibility. If conservative treatment does not relieve the pain, surgery may be recommended to relieve the pressure on affected nerves.

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To prevent osteoporosis, my pharmacist says that calcium carbonate is better absorbed while my chiropractor says that I should be taking calcium citrate for better absorption. Whoís correct, or does it matter?

The recommended daily allowance for calcium is approximately 1,200-1,500mg per day. This can come from either diet or supplements. There are many calcium tablets, including calcium carbonate (Tums, Oscal, Caltrate) and calcium citrate (Citacal). Either calcium tablet is generally well absorbed. However, there are certain conditions for which citrate is a better choice. Citrate is absorbed whether you have stomach acid or donít have stomach acid. Pernicious anemia is one disease in which stomach acid is reduced, and calcium citrate would therefore be the best choice. Calcium carbonate is best absorbed with stomach acid, and for this reason it should be taken with meals, which stimulate acid release.