What are Glucosamine and Chondroitin?
Glucosamine and chondroitin are actually two different molecules found in healthy joint cartilage. The medical theory behind taking these supplements is that they would help the body repair cartilage that has been broken down by osteoarthritis (the most common “wear-and-tear” form of arthritis). Some popular glucosamine supplements are derived from shellfish; chondroitin supplements are often derived from shark or cattle. Both can also be made synthetically. The supplements are sold and packaged much in the same way vitamins are. Like vitamins, they are not subject to review or approval by the U.S. Food and Drug Administration.

Make a plan with your doctor
Don’t assume that your doctor will not take your interest in nutritional supplements seriously. Many doctors understand how some supplements can complement your current arthritis treatment plan.4 Your doctor can also help you determine if a particular supplement is right for you given your overall health. Your doctor can also help monitor the effectiveness of your supplement regimen.

Do Glucosamine and Chondroitin help reduce arthritis pain?
Although the U.S. Food and Drug Administration has tentatively concluded that no studies to date have linked glucosamine and chondroitin to a reduced risk of developing osteoarthritis1, a large study administered by the National Institutes of Health has shown that glucosamine and chondroitin, when taken together, significantly reduce pain in patients with moderate-to-severe osteoarthritis of the knee.2 In fact, the study showed that people taking the supplements experienced the same amount of pain relief as people who took non-steroidal anti-inflammatory medications (NSAIDs)3 – long the go-to medication for people with arthritis pain. What sounds even better, treatment with glucosamine and chondroitin supplements has not been associated with any side effects. NSAIDs, on the other hand, have been associated with gastrointestinal side effects, including bleeding.3

A Word of Caution
Because vitamins and other nutritional supplements are not monitored by any federal agency to assure purity or dosage, you’ll want to do your homework before you purchase or consume anything. Look for a familiar, reputable brand name. If you have questions about the product, write to the manufacturer for more information. Ask your doctor about his or her experience with the supplement. And, most importantly, if you experience any adverse reactions, stop taking the supplement and call your doctor right away.

What is a Joint?

A joint is formed by the ends of 2 or more bones that are connected by thick bands of tissue called ligaments. For example, the knee joint is formed by the lower leg bone, called the tibia or shin bone, and the thigh bone, called the femur. The hip joint is a ball-and-socket joint, formed by the ball, or femoral head, at the upper end of the thigh bone, and the rounded socket, or acetabulum, in the pelvis.

The ends of the bone in a joint are covered with a smooth, soft material called cartilage. Normal cartilage allows nearly frictionless movement. The rest of the surfaces of the joint are covered by a thin, smooth tissue lining called the synovium. The synovium produces fluid that acts as a lubricant to reduce friction and wear in the joint.

Common causes of Joint Pain
One of the most common causes of joint pain is arthritis. The most common types of arthritis are:

Rheumatoid Arthritis (RA)
It produces chemical changes in the synovium that cause it to become thickened and inflamed. In turn, the synovial fluid destroys cartilage. The end result is cartilage loss, pain, and stiffness. RA affects women about 3 times more often than men1, and may affect other organs of the body.

Avascular Necrosis
It can result when bone is deprived of its normal blood supply. Without proper nutrition from the blood, the bone’s structure weakens and may collapse and damage the cartilage. The condition often occurs after long-term treatment with cortisone or after organ transplantation.

Obtaining a Quality Diagnosis
The medical management of arthritis and joint degeneration may be handled by a family doctor, an internist, or a rheumatologist. However, when medical management is not effective, an orthopaedic surgeon should be consulted to determine if surgery is an option. In some cases, the orthopaedic surgeon may be the first physician to see a patient and make the diagnosis of arthritis.

The Orthopedic Evaluation
While every orthopaedic evaluation is different, there are many commonly used tests that an orthopaedic surgeon may consider in evaluating a patient’s condition. In general, the orthopaedic evaluation usually consists of:

• A thorough medical history
• A physical examination
• X-rays
• Additional tests, as needed

A medical history is taken to assist the orthopaedic surgeon in evaluating your overall health and the possible causes of your joint pain.

What the physician sees during the physical examination, which includes standing posture, gait analysis (watching how you walk), sitting down, and lying down, helps confirm (or rule out) the possible diagnosis. The physical exam will also enable the orthopaedic surgeon to evaluate other important aspects of your hips and legs, including:

• Size and length
• Strength
• Range of motion
• Swelling
• Reflexes
• Skin condition

If you are experiencing pain in your hip joint, your back may be examined because hip pain may actually be the result of problems in the lower spine.

After the physical examination, X-ray evaluation is usually the next step in making the diagnosis. The X-rays help
show how much joint damage or deformity exists. An abnormal X-ray may reveal:

• Narrowing of the joint space
• Cysts in the bone
• Spurs on the edge of the bone
• Areas of bony thickening called sclerosis
• Deformity or incorrect alignment

Occasionally, additional tests may be needed to confirm the diagnosis. Laboratory testing of your blood, urine, or joint fluid can be helpful in identifying specific types of arthritis and in ruling out certain diseases. Specialized X-rays of the back can help confirm that hip pain isn’t being caused by a back problem. Magnetic Resonance Imaging (MRI) or a bone scan may be needed to determine the condition of the bone and soft tissues of the affected joint.

In order to assist the orthopaedic surgeon in making a diagnosis, it may be helpful to write down your answers to the following questions before the appointment:

• Where and when do I have pain?
• How long have I had this pain?
• Do I have any redness or swelling around my joints?
• What daily tasks are hard to do now?
• Did I ever hurt the joint or overuse it?
• Does anyone in my family have similar problems?

Total joint replacements of the hip and knee have been performed since the 1960s. Today, these procedures have been found to result in significant restoration of function and reduction of pain in 90% to 95% of patients.1 While the expected life of conventional joint replacements is difficult to estimate, it is not unlimited. Today’s patients can look forward to potentially benefiting from new advances that may increase the lifetime of hip and knee prostheses.

Recent Advances in Total Joint Replacement

Approximately one million hip and knee replacements are performed each year in the U.S.¹ As successful as most of these procedures are, over the years, the artificial joints can become loose and unstable, requiring a revision (repeat) surgery.

These issues – together with the fact that increasing numbers of younger and more active patients are receiving total joint replacements, and older patients are living longer – have challenged the orthopaedic industry to try to extend the life of total joint replacements.

Recent improvements in surgical techniques and instrumentation can help to further the success of your treatment. The availability of advanced materials, such as titaniumand ceramic prostheses and new plastic joint liners, provides orthopaedic surgeons with options that may help to increase the longevity of the prosthesis.

Preventing Possible Complications of Surgery
The complication rate following joint replacement surgery is very low. Serious complications, such as joint infection, occur in less than 2% of patients.¹ Nevertheless, as with any major surgical procedure, patients who undergo total joint replacement are at risk for certain complications — the vast majority of which can be successfully avoided and/or treated. Possible complications includes:

Infection
Infection may occur in the wound or within the area around the new joint. It can occur in the hospital, after the patient returns home, or years later. Following surgery, joint replacement patients receive antibiotics to help prevent infection. For the rest of their lives, they may also need to take antibiotics before undergoing even minor medical procedures to reduce the chance of infection spreading to the artificial joint.

Blood Clots
Blood clots can result from several factors, including the patient’s decreased mobility following surgery, which slows the movement of the blood. There are a number of ways to reduce the possibility of blood clots, including:

• Blood thinning medications (anticoagulants)
• Elastic support stockings that improve blood circulation in the legs
• Plastic boots that inflate with air to promote blood flow in the legs
• Elevating the feet and legs to keep blood from pooling
• Walking hourly

Lung Congestion
Pneumonia is always a risk following major surgery. To help keep the lungs clear of congestion, patients are assigned a series of deep breathing exercises.

Getting Moving Again
It may come as a surprise to you that total joint replacement patients are encouraged to get up and start moving around as soon as possible after surgery — as early as the day of surgery.

When you are medically stable, the physical therapist will recommend certain exercises for the affected joint. Physical therapy is a key part of recovery. To ease the discomfort the activity will initially cause, pain medication is recommended prior to therapy. In addition, the physical therapist will discuss plans for rehabilitation following hospital discharge.

Depending on your limitations, an occupational therapist may provide instruction on how to use certain devices that assist in performing daily activities, such as putting on socks, reaching for household items, and bathing. A case manager will discuss plans for your return home and will ensure that you have all the necessary help to support a successful recovery.

Life After Total Joint Replacement
The vast majority of individuals who have joint replacement surgery experience a dramatic reduction in joint pain and a significant improvement in their ability to participate in the activities of daily living. However, joint replacement surgery will not allow you to do more than you could before joint problems developed. Your doctor will recommend the most appropriate level of activity following joint replacement surgery.

In the weeks following total joint replacement, certain limitations are placed on every patient’s activities. Using a cane or walker may be necessary for several weeks. Kneeling, bending, and jumping will likely be forbidden for the first month. It may be 6 weeks before driving is permitted. Your orthopaedic surgeon and physical therapist will provide specific recommendations.

When fully recovered, most patients can return to work, although some types of work — such as construction work, certain types of carpentry, and occupations that involve repeated or high climbing — may not be advisable for individuals with a joint replacement. Also, athletic activities that place excessive stress on the joint replacement, such as skiing, basketball, baseball, contact sports, distance running, and frequent jumping, should be avoided.

After joint replacement, a good rule of thumb is that acceptable physical activities should:

• Not cause pain, including pain felt later
• Not jar the joint, as happens with running or jumping
• Not place the joint in the extremes of its range of motion
• Be pleasurable

It is also important for an individual with a joint replacement to keep his or her body weight as close to normal as possible. Joint wear and loosening increases with weight increase.

Talk to Your Doctor
Don’t let joint pain slow you down. If you have not experienced adequate results with medication and other conservative treatments, total joint replacement may provide the pain relief you long for – and the resulting return to your favorite activities.

Write down a list of questions about your condition, your concerns, and the ways that total joint replacement might benefit you. Then make an appointment to talk to your doctor – and make note of his or her answers and recommendations.

Remember, even if your doctor determines that joint replacement is a good medical option for you, it is still up to you to make the final decision.