Ask the Doctors March 2007 Issue

Ask The Doctors: 03/07

I had a total replacement of my left hip 15 years ago, and am now experiencing osteoly-sis. Iím now suffering from arthritis pain in my right hip. Iíd like to delay a total re-placement of my right hip. Are cortisone or Hyalgan injections a safe alternative? If I decide on hip replacement, should my right hip be replaced first, or should my first replacement (on my left hip) be re-done?

Although both cortisone and hyaluronan injections have been successful in some patients with osteoarthritis of the knee, they are seldom used for arthritis of the hip.

In contrast to knee injections, injecting a hip joint is difficult and cannot be done in an office setting. In order to make sure the needle consistently finds its way into the joint space of the hip, special radiology equipment, such as an ultrasound or fluoroscopy machine, is usually needed.

A hip-joint injection is much more uncomfortable for the patient than a knee-joint injection. Also, for reasons that are not entirely clear, hip-joint injections do not appear to work as well as knee-joint injections. For these reasons, there has been little research on cortisone or hyaluronan injections for hip-joint arthritis, and most doctors donít recommend them.

As far as which hip replacement should be done first, it seems reasonable to replace the hip joint that is causing you the most pain and activity limitation.

Osteolysis alone is rarely painful until there is an actual or impending fracture, or the implant becomes unstable. Your doctor can obtain special radiographic images to determine the amount of osteolysis and help determine which hip replacement should be performed first.

Iím 86 and have been diagnosed with spinal stenosis. My doctor says my pain, primarily on my right side, is caused by the nerves com-ing out of my spine, which impinge on my ver-tebrae. Iíve started cortisone injections, but if they donít work my doctor may try a "radioactive motive," instead of a spinal stenosis operation, to remedy the situation. What is a radioactive motive, and how is it likely to help?

Iím unsure as to what your doctor means by a "radioactive motive." Radiation therapy has been used in the past for the treatment of such spinal disorders as ankylosing spondylitis based on the belief that radiation can reduce inflammation and prevent further bony spur formation. However, the associated risk of malignancy turned out to be too great to justify this method of treatment. The use of some newer radioactive materials has been reported in Europe, but these are not currently approved for use in the U.S. and the risk of malignancy with these materials has not yet been determined.

Any type of radioactive treatment is unlikely to be beneficial if your stenosis has advanced to the point that it causes arm pain. An anesthetic injection (nerve block) near the affected nerve may provide temporary relief. Surgical decompression of the nerve by the removal of the lamina (roof) of one or more vertebrae will provide more long-lasting results.

Iíve just been diagnosed with muscular rheumatism. Is this some form of arthritis?

Though "muscular rheumatism" is not an accepted term in rheumatology, muscular aches and pains often do occur as part of an arthritic condition. In supporting joints that may be inflamed, muscles attempt to splint the joint and can get sore. There are diseases, such as polymyositis, that directly attack the muscles, causing muscle inflammation and elevation of the enzymes in the blood.This condition is usually treated with prednisone as primary therapy, often in combination with an immunosuppressive agent such as methotrexate or imuran.