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Smart moves for arthritis

Posted Saturday, May 20, 2006

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Exclusive Survey of Patients’ Experiences with Knee and Hip Replacement Surgery; Myths and Facts about Arthritis; Independent Test Results for Joint Supplements

In Consumer Reports National Research Center’s exclusive survey, 1,001 knee- and hip-replacement patients tell about the experiences they’ve had with joint replacement surgery. This unbiased survey, based on a nationally representative sample, found that although the surgery can have serious complications—and does not always return patients to a state of perfect mobility—it succeeds at the most basic level: pain relief. Even patients who were the most disabled going into surgery reported that on average, they had minimal pain in their new joints six months afterward.

Highlights of CR’s survey findings, published in the June issue, include:

  • Eighty-two percent of our respondents described themselves as “very” or “completely” satisfied with their new joint. But not all of our results were so encouraging: Recovery is long and sometimes painful. While most people stopped taking their pain medication after two months, 12 percent were still taking it after a year. Although 90 percent or more of patients could perform routine activities after a month, one-third of hip patients and one-quarter of knee patients said they still couldn’t walk a half-mile one year after the surgery.
  • Five percent of respondents reported getting an infection shortly after the surgery, a significantly higher rate than reported in some major studies. Secondary complications were relatively common. These include a seriously weakened or contracted muscle. Thirteen percent of hip-replacement patients and 7 percent of knee-replacement patients said they ended up with legs of unequal length. Five percent of all patients required another operation to correct problems cause by the first one.
Some of the advice CR offers people considering the surgery includes:
  • While conventional medical advice says to delay joint replacement as long as possible, CR’s survey suggests this strategy may have disadvantages. CR found that respondents with the most severe and long-standing disabilities at the time of their surgery fared much worse than those who underwent surgery when they were less impaired. In general, CR suggests discussing surgery with your doctor or seeing an orthopedic surgeon if the pain makes it difficult to sleep at night, medication doesn’t alleviate the pain or has produced unacceptable side effects, you have trouble with the basics of living or the pain rules out everyday activities.
  • Choose a surgeon who does no fewer than 50 per year of the procedure you’re seeking. Look for someone who does only hips and knees and nothing else.
  • Take steps to prevent infection, including making sure you receive an intravenous dose of preventive antibiotics in the hour before surgery.
  • Of all the variables CR asked about, complying with the exercises and activity prescribed by the physical therapist was one of the strongest predictors of how patients fared after the surgery. Respondents who said they followed the therapist’s advice walked on their own considerably sooner, suffered fewer complications during recovery, and were significantly more satisfied with the surgery overall.
CR outlines low, moderate, and high-impact joint-safe workouts for easing symptoms of arthritis in its report.
 
Myths surround arthritis, American’s #1 cause of disability and one of the most painful and frustrating chronic conditions. While most patients will need at least some pain medication some time in their lives, drugs are not the only way to control arthritis pain. Heat, cold packs, creams, braces, wedge shoe insoles, glucosamine and chrondroitin, acupuncture, massage, and relaxation training are some other methods that can work. People who take drugs for arthritis don’t need to get rid of the inflammation to relieve the accompanying pain. Acetaminophen, which doesn’t affect inflammation, should be the first drug you try for arthritis. Though not effective for everyone, it can often relieve even moderate to severe pain and doesn’t cause gastrointestinal bleeding that is a serious side effect of NSAIDs. CR also discusses myths and facts about exercise, injections to relieve pain, and arthroscopic surgery. A complete report on pain relievers is available free online at www.CRBestBuyDrugs.org.
 
Consumers spend hundreds of millions of dollars a year on dietary supplements to relieve osteoarthritis symptoms, but our analysis of the research and CR’s interviews with experts indicate that it may be worth trying only one such supplement, glucosamine plus chondroitin. However, CR’s independent tests found that not all glucosamine-chondroitin products are alike: Some of them contain less of the active ingredients than their label says. To help consumers wade through the confusion surrounding supplements and make a well-informed buying decision, we tested the amount of glucosamine and chondroitin in 17 mainstream and four dollar-store products. Some of CR’s test results include:
  • The following products contained less than the labeled amount of glucosamine or chondroitin: 21st Century Triple Strength Glucosamine & Chondroitin 3X; Glucoflex Glucosamine & Chrondroitin Sulfate Triple Strength; FlexAble Glucosamine & Chondroitin Sugar Free Chewables with Vitamin C; and Trader Darwin’s Glucosamine-Chondroitin.
  • The GNC, CoasminDS, 21st Century, and Trader Darwin’s products CR tested recommended daily doses smaller than those used in successful clinical trials.
  • The chondroitin level was inadequate or only marginally adequate in three of four dollar-store products.
  • The cost of acceptable mainstream products varied greatly, from 25 cents to $1.25 a day.
If you want to try these supplements, pick a product at the lowest price that supplies 1,500 milligrams of glucosamine and 1,200 milligrams of chondroitin per day. Be wary of dollar store brands, as our experience suggests mainstream brands may be more reliable. CR recommends Kirkland Signature Extra Strength Glucosamine HCI and Chondroitin Sulfate (Costco); Spring Valley Glucosamine & Chondroitin Double Strength (Wal-Mart); Target Triple Strength Glucosamine & Chondroitin Complex; Vitamin World Glucosamine Chrondroitin Double Strength; and VitaSmart Double Strength Glucoasime & Chondroitin (Kmart).

Individuals who are allergic to shellfish should avoid glucosamine. Those with diabetes should closely monitor their blood sugar level. People who have a clotting disorder or take a prescription anti-clotting drug may want to avoid chrondroitin.

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For more unbiased information on the safety and efficacy of dietary supplements visit the new Natural Medicine Ratings at www.ConsumerReportsMedicalGuide.org. The June 2006 issue of Consumer Reports is on sale May 9th wherever magazines are sold. To subscribe, call 1-800-765-1845.

 
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