Ask the Doctors December, 2011 Issue

Ask The Doctors: December 2011

Hip Replacement . . . Meds That Cause Osteoporosis . . . Building New Cartilage

Q. Iím scheduled for hip replacement surgery next month. What can I expect to undergo prior to surgery?

A. Preparation for a total joint replacement is an important part of your overall care. It includes a complete health evaluation, laboratory studies, a nutritional assessment, a session with a physical therapist, and patient information concerning your surgery. Youíll learn about total joint replacement and why postoperative care is important in achieving good results. A physical therapist will familiarize you with post-operative exercises prior to surgery. After surgery, youíll receive pain medications and physical therapy procedures. Youíll also learn why following the postoperative plan is important to achieve maximum results.

Good nutrition is importantólack of proper nutrition can lead to complications, such as wound-healing problems. If there is a serious nutritional problem, it will have to be addressed prior to surgery.†

The goal of your preoperative evaluation is to decrease the risk of complications during your surgery and to allow the postoperative course to proceed smoothly.

Q. Iíve heard that some medications can lead to osteoporosis. Which ones are they? Also, at what point, or under what circumstances, should someone have a bone density test?

A. Fortunately, very few arthritis medications cause osteoporosis. Two that can cause osteoporosis, however, are corticosteroids and methotrexate, medications that are frequently used in the treatment of rheumatoid arthritis (RA). When used in the low doses that are commonly prescribed for RA, methotrexate will not cause osteoporosis. It is only when methotrexate is used in large doses in the treatment of malignancies that osteoporosis can result. On the other hand, the chronic use of steroids, which are also frequently prescribed for RA, can lead to osteoporosis.

A baseline bone density test should be obtained whenever steroid therapy is begun. Repeat bone density tests should be performed every two to three years to check on the progress of osteoporosis. It is becoming common practice to prescribe alendronate (Fosamax) to lessen the degree of osteoporosis caused by steroids. Alendronate, and drugs like it, decrease bone resorption, thus increasing bone mass.

Q. Iíve seen ads for herbs and special supplements that claim to rebuild worn cartilage. Do any of these treatments work? If not, are there any procedures or treatments that do work in rebuilding cartilage?

A. No herbs, dietary supplements, or home remedies have been proven to rebuild damaged cartilageóand you should be wary of any ads that claim their product does so.†

Surgical procedures can rebuild a type of cartilage, called fibrocartilage, but it is a poor substitute for articular cartilage. Fibrocartilage is produced by arthroscopically drilling small holes in the bone, but it does not hold up well against the stress of everyday walking or athletic activities.†

Cartilage can be transplanted from other areas to the area of deterioration. This procedure, which is called mosaicplasty, can be done for small areas of cartilage damage. Neither procedure can be performed for large areas of cartilage damage, such as that seen in osteoarthritis.