In The News: June 2010
Patient-Doctor Joint Replacement Expectations Often at Odds
A new study reveals that doctor and patient expectations about knee and hip replacements are often not aligned. The study, unveiled during a March meeting of the American Academy of Orthopaedic Surgeons, included 42 patients who were scheduled to receive a hip or knee replacement by a dedicated hip or knee surgeon. After comparing expected outcomes, researchers found meaningful disagreement in 68 percent of the patients, with 53 percent of the patients’ expectations exceeding the expectations of their surgeons. The take-home message for surgeons, said researchers, is that educational programs, such as a preoperative class, be used to better align patient-surgeon expectations. For the patient, said the researchers, pain relief and function expectations should be discussed with the surgeon and in the class before undergoing a total joint replacement to make sure that the expectations of the physician and the patient are similar.
Osteoporosis Drugs Linked to Decrease in Breast Cancer Risk
Women who use some types of bone-building drugs to prevent and treat osteoporosis may be at lower risk for breast cancer. A recent study, published in the British Journal of Cancer, found that women who used bisphosphonate drugs, such as alendronate sodium (Fosamax), ibandronate sodium (Boniva) and zoledronic acid (Zomita), for more than two years had a nearly 40 percent reduction in breast-cancer risk compared to those who did not. The study involved nearly 6,000 women age 20 to 69. Although the way in which these drugs may prevent breast cancer is not known, researchers suggested that the drugs may affect cell function and be significant in cell growth and the death of tumors. Researchers also found that some kinds of bisphosphonates cause tumor apoptosis (cellular suicide), inhibit angiogenesis (prevent tumors from establishing a blood supply), and prevent tumor-cell adhesion (the ability of cancer cells to bind to one another).
Traffic Pollution May Increase RA Incidence
People who live near major roads, and the traffic pollution they generate, may be in greater danger of developing rheumatoid arthritis (RA). A Nurses Health Study comparing the medical records of more than 90,000 women found that those who lived within 165 feet of interstates or primary, multi-lane roads had a 63 percent increased risk of developing RA compared with women who lived more than 650 feet, or approximately one-tenth of a mile, away from major thoroughfares. The risk remained elevated even after eliminating the effects of age, race, gender, socioeconomic status, and smoking. The findings fit with previous research which found that people living in the Midwest and Northeast, areas with high levels of pollution, have higher risks of developing RA than those living in the West. The culprits, said researchers, are particulates—tiny bits of soot or dust mixed with droplets of acids or organic chemicals. The smallest particulates pass through the nose and mouth and enter the lungs, where they can trigger an immune reaction.
Flexible Shoes Judged Best for Knee OA
Flip-flops and sneakers with flexible soles are easier on the knees than clogs or special walking shoes, according to a recent study in Arthritis Care & Research. The gait of 31 patients with knee osteoarthritis (OA) was analyzed as they walked with four popular shoe types: clogs, which are often worn by healthcare professionals who have to be on their feet much of the day; "stability" shoes, which frequently are prescribed for foot comfort and stability; a flat athletic shoe with flexible soles; and flip-flops. For the clogs and stability shoes, loads on the knee were up to 15 percent greater than those experienced with the flat, flexible shoes or flip-flops. Despite these results, researchers cautioned that knee loading should not be the only consideration when selecting a proper shoe. "For the elderly or infirm, flip-flops could contribute to falls because of their loose-fitting design," they explained, urging that such factors be taken into account in any decision involving the purchase or prescription of arthritis-suitable shoes.