Ask the Doctors October 2010 Issue

Ask The Doctors: October 2010

Knee Replacement Pain . . . Prolotherapy . . . Alcohol Use . . . Exercise and OA

I had a total knee replacement several months ago, but my pain has continuedóand on some days itís even worse than before surgery. Is this normal?

Not if the pain is severe. Some aching is normal, but you should not be experiencing severe pain.

After physical therapy, the knee can be sore from bending and straightening exercises. In the first three months, pain can be attributed to the surgery itself, but after three months, other sources of pain should be investigated. By and large, knee pain should be tolerable by the end of the third month, although total rehabilitation after surgery will take several months.

Consult with your physician to determine the source of your pain and what can be done to alleviate it.

I have arthritis of the hip and have been looking into what alternatives I have, if any, other than surgery. Iíve heard of a procedure called prolotherapy. Do you have any advice on this procedure?

Prolotherapy has been practiced for more than 60 years. The name is derived from the word "proliferation."

Advocates claim that the injection of dextrose solution into a damaged ligament or tendon causes a localized inflammation that increases the blood supply and promotes healing. The treatment is claimed to increase the flow of nutrients, causing a proliferation of new ligament or tendon tissue. The practitioner usually recommends multiple injections over time.

The scientific basis for prolotherapy is sparse, unconvincing, and dates back to the 1980s. This unproven treatment should not be considered as a replacement for the conventional and clinically proven medical and surgical treatment of arthritis.

Is there any evidence of a relationship between arthritis and the consumption of alcohol?

Similar to other medical conditions, there are risk factors that increase an individualís chance of developing osteoarthritis (OA). Included among the risk factors for OA are joint injuries due to sports or work-related activities, obesity, and genetic predisposition. The consumption of alcohol is not generally considered a risk factor for OA.

Alcohol consumption does play a role in other conditions similar to arthritis, such as osteonecrosis, a disease that leads to bone breakdown. It may also play a role in the triggering of certain types of gout attacks. Moderate use of alcohol, however, does not play a role in the development of OA.

Arthritis Advisor often recommends exercise for people with osteoarthritis. But canít some exercises actually cause arthritis, or make it worse?

To cause osteoarthritis (OA), a joint motion must be repeated thousands of times over a longer period of time, usually many years. Strengthening and range-of-motion exercises commonly prescribed for people with arthritis will never cause OA. These exercises, by their design, do not place excessive stress on the joint and normally are not continued for long periods.

Physical therapy exercises, on the other hand, can cause OA symptoms to become worse. If the arthritis is severe, the stress of physical therapy can irritate the joint, causing increased pain. If this happens, it should be reported to your physical therapist, and the program should be modified.