News July 2007 Issue

In The News: 07/07

Chondroitin Not Effective For Hip And Knee Arthritis

Chondroitin, a dietary supplement often sold in combination with glucosamine and marketed as a treatment for osteoarthritis, has

been found to be ineffective in relieving the pain of hip and knee arthritis. Researchers at the University of Berne, Switzerland, who reported their findings in the

Annals of Internal Medicine, examined 20 previously published trials of 3,846 patients and found the benefit of chondroitin to be either minimal or nonexistent. Another seminal, large-scale 2006 study concluded that the supplement, in combination with glucosamine, helped patients with moderate-to-severe pain but not mild-to-moderate arthritis. Critics of the Swiss study argued that a distinction should be made between degree of disease severity in evaluating the effectiveness of chondroitin. Nonetheless, authors of the study maintain that the use of chondroitin in routine clinical practice should not be recommended and should even be discouraged.

Surgeons Warn Against Minimally Invasive Hip Surgery

Although many patients considering total hip replacement view minimally invasive surgery (MIS) as an attractive alternative to

open hip replacement (the incisions are smaller and leave smaller scars), the procedure offers few advantages. In fact, it has several disadvantages, according to research presented during a meeting of the American Academy of Orthopaedic Surgeons (AAOS). The downside, researchers claim, includes longer operative time, greater anesthesia requirements, risk of more muscle damage, and sometimes poor positioning of the implants. (The AAOS claims there is no difference in recovery time between the two procedures.) A review turned up no study that showed any significant advantages compared with open hip replacement, and two studies reported higher complication rates. It was recommended that surgeons make the smallest incision that still permits a successful surgery, suggesting that incisions be made two to three inches longer to prevent complications.

Post-Surgery NSAID Use Impedes Fracture Healing

An animal study supports evidence that using nonsteroidal anti-inflammatory drugs (NSAIDs) immediately after a fracture may

prevent healing. According to a report in the

Journal of Bone and Joint Surgery, the use of celecoxib (Celebrex) significantly impaired the healing of a fracture if administered during the first 14 days after the fracture. However, celecoxib use prior to fracture or after a fracture’s early stages of healing did not delay healing. The study suggests that inflammation that normally occurs at the beginning of fracture healing provides the molecules that are needed to sustain bone healing. Another study, conducted with humans to gauge the effect of indomethacin (Indocin) on fracture healing, turned up somewhat similar results. The rate of fracture nonunion was 7 percent in patients who underwent radiation therapy and 29 percent in those who received indomethacin.

 

Ibuprofen May Increase Heart Problems In High-Risk Patients With OA

Ibuprofen, the common pain-reliever, may increase the likelihood of a heart attack in high-risk patients who have osteoarthritis. A

study in the Annals of Rheumatic Disease compared the cardiovascular health over a one-year period of 18,000 patients over age 80 with osteoarthritis. Participants were taking lumiracoxib (a COX-2 inhibitor currently under development in the U.S.), ibuprofen, or naproxen. Although there was no difference in the number of heart attacks among those at low risk, regardless of their drug treatment, high-risk patients on aspirin and ibuprofen were nine times more likely to have heart attacks during the year as those on lumiracoxib. Among high-risk patients not taking aspirin, the rate of heart attacks was higher for those on lumiracoxib than it was for those on naproxen, but no higher than for those on ibuprofen. The study’s authors suggested that ibuprofen may promote platelet aggregation by interfering with the blood-thinning properties of aspirin in patients at cardiovascular risk.