Glucosamine and Chondroitin Sulphate
Arthritis is a very common and painful condition affecting millions of Australians. There are a number of medications which may be helpful in relieving pain. There are also numerous alternative treatments and nutritional supplements available.
Glucosamine and Chondroitin Sulphate are natural substances found in the body. The tablets sold in chemists are made from mineral products. Their function is to stimulate the repair of cartilage.
There is no clear scientific evidence that either of these substances reverses arthritis. Studies have been published which show conflicting results. Some report that patients benefit from the medication and others do not. There are ongoing studies around the world which will hopefully answer this question.
A study published in March 2000 in the Journal of the American Medical Association by Dr McAlinden recommends that additional rigorous independent studies be done on these compounds to determine their true efficacy and usefulness. Dr McAlinden said he would not discourage patients from trying these compounds “but there is a possibility that they might not work”.
There is no doubt that they do relieve pain in some people. There is little risk involved in taking them as side effects are very rare. The down side is the financial cost involved.
There are a number of products sold in chemists and not all of them contain the correct dosages so consult with your doctor and pharmacist prior to purchasing them. Stick with a reputable manufacturer and remember the cheapest is not always the best.
How long will my appointment take?
No two patient visits are exactly alike. The length of your consultation will depend on the complexity of your condition and whether further investigations or hospital admission will be required. Your time is valuable and we make every effort to run on time. As you can imagine, emergencies occur that cause scheduling delays beyond our control. We apologise in advance if we keep you waiting.
Infection at site of joint Replacement
Infections can occur in joint replacements at any time and hence precautions need to be taken. If you have an infection anywhere or a fever you should be treated immediately by your local doctor.
Common sources of infection include urinary tract infections, infected toe nails, skin lesions, throat infections, gum or dental infections.
Recommendations for antibiotic prophylaxis are controversial. Most people agree that it is recommended for…
- dental work which may cause bleeding, and
- any endoscopic (bowel or bladder) which again may cause bleeding.
Essentially you should probably take the medication unless you are sure your doctor is not going to do anything apart from look.
The recommended prophylaxis is Amoxicillin 3g, 1 hour before and Amoxicillin 1.5g, 6 hours after procedure.
If you are allergic to penicillin the drug of choice is Erythromycin 1000mg before and 500mg after.
Medical management of osteoarthritis
Osteoarthritis is a common problem of the major joints. Typically, the patient feels pain (especially with weight bearing) and stiffness when having been still for a period of time and loss of movement of the joint. Looking inside the joint one sees loss of joint lining cartilage, remodelling of bone, thickening of surrounding tissues and swelling of the joints.
The principals of treatment are:
- Weight loss.
- Mechanical aids.
- Simple pain killers.
- Non steroidal anti-inflammatory tablets.
- Drugs such as Glucosamine or Chondroitin Sulfate.
- Narcotic drugs.
- Intra-articular injections of steroid or synthetic joint fluid.
Points To Remember:
Even losing as little as 5kg of weight can significantly reduce your long term symptoms.
Inactivity from pain leads to reduced muscle bulk around the joint, instability and loss of shock absorption ability of the muscles. Restoring these muscles can improve range of movement, strength and stability and reduce pain. This exercise is best performed in a non weight bearing fashion such as swimming or hydrotherapy. Low impact exercise is also beneficial.
Simple interventions such as shock absorbing footwear, adequate arch supports and heel cushions and use of a walking stick in the hand opposite to the affected leg, typically reduce pain significantly.
Surgery is a last resort for patients with osteoarthritis and most people will manage very well without surgical intervention.
Osteoporosis is a reduction in the volume of bone found usually without any change in its absolute mineral content. Up to 50% of all women and 30% of men may suffer fractures related to decreased bone density during their lifetime.
Bone is constantly undergoing a remodelling process with some being made and some being reabsorbed by the body in a constant process. As one ages, the volume of bone reabsorbed outstrips the volume replaced and a gradual loss of bone occurs. In women this is accelerated after menopause.
There are drugs available these days which can reduce fracture risk and the newer drugs have fewer side effects than previously noted.
Drugs are more important as patients age, as their bone mineral density decreases and also if they have had prior fractures. Each contribute independently to an increased fracture risk. 85% of fractures occur in women over 60 years of age and if you have had one fracture, you are much more likely to have another. General preventative measures during your lifestyle can help prevent your risk of osteoporosis. These include increasing your calcium intake, exercising in a weight bearing fashion, avoiding excesses of alcohol and tobacco and getting adequate sunshine for Vitamin D production.
Generally speaking, women under 60 years of age do not need treatment unless they have a specific risk factor.
In women over 60 years of age, the ultimate aim is to prevent hip fractures and a diphosphinate may be used in women over 70 years of age with a low femoral neck (hip) bone mineral density.
Popliteal or baker's cysts
A cyst is a fluid filled sac in any location of the body. The most common around the knee is called a Baker’s cyst or popliteal cyst. There is a one way valve which goes from the knee to this sac in the back of the knee. Typically, damage within the knee causes swelling and the fluid is pumped from the knee to this fluid filled sac. This creates swelling and sometimes pain in the back of the knee. This may cause problems achieving full bending or full straightening of the knee.
Typically, draining or cutting out this cyst does not help unless the source of the fluid inside the knee is fixed at the same time. Usually it means that arthroscopy is necessary to fix or remove torn menisci or joint lining cartilage. Over time, the cyst usually disappears or reduces in size and does not need drainage or removal.
Occasionally these fluid filled sacs burst and cause swelling and fluid to travel down the back of the calf. This can be quite painful for up to three months and has a slightly higher risk of causing blood clots in the leg, but is usually self limiting.
Smoking and surgery
There have been studies showing significant differences in infection rates between smokers and non-smokers. While reducing smoking certainly makes your anaesthetic safer, it is important to quit smoking completely in order to reduce the potential complications at surgery.
This is particularly true of wound infections and pressure sores. The optimum period of stopping smoking is probably at least six weeks and may be related to the toxic combustion by-products of smoking. While nicotine is sometimes blamed for this, nicotine replacements such as patches, do not seem to increase infection rates in joint replacement surgery.
We strongly recommend that smoking is stopped completely six weeks prior to considering any elective surgical procedures.
What should I expect during my first visit?
What's not covered by Medicare?
Medicare does not cover such things as the following…
- Private patient hospital costs (for example, operating theatre fees or accommodation).
- Medical costs for which someone else is responsible, for example, a compensation insurer, an employer, a government or government authority).
- Medical services which are not clinically necessary.
- Physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services or podiatry.
- The cost of prostheses.
- Medical and hospital costs incurred overseas.
- Dental examinations and treatment.
- Ambulance services.
- Home nursing.
- Acupuncture (unless part of a doctor’s consultation).
- Glasses and contact lenses.
- Hearing aids and other appliances.
- Surgery solely for cosmetic reasons.
- Examinations for life insurance, superannuation or membership of a friendly society.
Private health insurance can be arranged to cover many of these services.