News January 2007 Issue

In The News 01/07

Exercise Before Hip Or Knee Surgery Reduces Rehab Need

Although the level of function prior to knee or hip replacement has been shown to be strongly related to how well a patient functions after surgery, little has been known about the effects of pre-op exercise on post-op rehab. A recent study to determine those effects included 108 patients scheduled for hip or knee replacement. The patients were divided into two groups: 54 participated in water and land-based exercise three times a week for the six-week period before surgery and 54 received only educational materials. Exercisers participated in strength training, aerobics, and flexibility exercises supervised by a physical therapist. Results showed that patients who exercised reduced their odds of discharge to an inpatient rehabilitation facility by 73 percent and were more likely to walk more than 50 feet at the time of hospital discharge. Patients did respond somewhat differently depending on what joint was being replaced, a fact that prompted researchers to suggest the need for different approaches for patients suffering from OA of the hip or knee.

Potassium Citrate Boosts Bone Mass

Potassium citrate supplements may increase bone mineral density (BMD) as effectively as current medications. In a 12-month study of 181 postmenopausal women with osteopenia conducted by researchers at the University of Basel in Switzerland, investigators found that potassium citrate therapy resulted in a nearly 2 percent increase in lumbar spine and hip BMD. The results suggest that potassium citrate partially reverses the high acidity of the modern Western diet high in acid-generating protein (meat and dairy products) which results in better skeletal health.

Total Hip Replacement Also Eases Back Pain

In addition to improving hip pain and function, total hip replacement can also relieve back pain and improve spinal function. So concludes a recent study of 15 female and 10 male patients (mean age 67 ). Investigators found that lower-back pain was alleviated, and spinal function was significantly improved, following total hip replacement. Differentiating hip disease from spine disorders, such as spinal stenosis, is often a challenge; researchers nevertheless concluded that total hip replacement should be considered more often for patients with hip OA who also have lower-back pain. Total hip replacement, investigators explained, not only relieves flexion deformity in the hip but restores normal posture while walking.

Nicotine Interferes With Tendon-To-Bone healing

Hereís another reason not to smoke: Nicotine may impede the ability of tendons to reattach to bones, suggesting one reason for the failure of a rotator-cuff repair. Although smoking is known to be at the root of a variety of physical disorders, including cardiovascular failure and lung disease, as well as interfering with the healing of bone fractures, little has been known about the effect of smoking on tendon and ligament strength. A recent study evaluating the effects of smoking on rotator-cuff repair found that when rats were exposed to nicotine following surgery, shoulder-joint inflammation persisted for a prolonged period. Researchers also noted less cellular proliferation in the ratsí repaired shoulders and reduced collagen production, which also led to delayed healing.

Acupuncture Benefits Knee, Hip OA

Given the recent rap on anti-inflammatory drugs and their potential side effects, itís not surprising that osteoarthritis sufferers have increasingly turned to other forms of treatment for their pain including acupuncture. Perhaps with good reason. A German study of 3,633 patients with OA pain in the knee or hip (mean age 61) found that when acupuncture is combined with routine medical care, significant improvements in symptoms result. Each patient was monitored for six months, and a 321-patient control group (routine care only) received acupuncture during only the last three months. In both groups, improvements in pain and function were significant, with scores virtually the same.