Anthony M. DiGioia III, MD

Several studies have had mixed results about the benefits of quadriceps strength on knee arthritis.  Some show that weaker quadriceps are associated with greater knee pain and impaired function while others do not show a difference.  Most of the studies, however, focus on the main part of the knee where the femur (thigh) and tibia (shin) bones meet the tibiofemoral joint, neglecting to include the area of the knee where the patella (kneecap) and femur meet (patellofemoral joint).

A new study out has looked at both areas of the knee as well as knee arthritis symptoms.  The authors studied 265 men and women for 30 months.  Baseline MRIs were obtained as well assessment of quadriceps strength, severity of knee pain, physical function and knee alignment. 

The results showed that greater strength had no influence on cartilage loss at the tibiofemoral joint, but greater strength did protect against cartilage loss at the outer part of the patellofemoral joint, a common site for cartilage loss.  Also, those with the greater quadriceps function had less knee pain and better physical function.  The authors of the study believe that greater strength of the vastus medialis (part of quadriceps muscle) helps to pulls the kneecap inward, stabilizing and preventing cartilage loss.

Furthermore, several short-term studies have shown that greater quadriceps strength is associated with improved knee function and less pain.  The bottom line . . . keep those muscles in shape!!

URL: http://www.medicalnewstoday.com/articles/135408.php

Shreyasee, A.  "Quadriceps Strength and the Risk for Cartilage Loss and Symptom Progression in Knee Osteoarthritis."  Arthritis and Rheumatism 60:1 (2009): 189-198.

Osteoarthritis of the Knee

• Leading cause of physical disability
• 33 million Americans affected
• Most common in aged 65 or older
• Affects activities of daily living like climbing stairs or walking

Symptoms include:

• Pain
• Joint stiffness
• Swelling in knee

Factors that increase a persons risk of developing osteoarthritis:

• Heredity
• Weight
• Age
• Gender
• Injuries or trauma to the knee
• Poor posture or bone alignment
• Lack of aerobic exercise and muscle weakness

The AAOS Guidelines and Evidence Report Recommendations:

AAOS recommends:

• Patients should be encouraged to begin or increase their participation in low-impact aerobic fitness.
• Patients who are overweight should lose a minimum of 5% of their body weight
• Overweight is a body mass index (BMI) of greater than 25
• you can calculate your own body mass index by multiplying your weight in pounds by 703 divided by your height in inches
• Weight loss has the highest potential to slow the progression of osteoarthritis

• AAOS recommends for pain control:
• Tylenol
• NSAIDs (common include ibuprofen and naprosyn)
• Steroid injections into the knee like depomedrol or cortisone

• AAOS recommends against:
• Glucosamine and or chondroitin sulfate or hydrochloride
• Drawing fluid from the knee with a needle
• Custom made foot orthotics or foot supports
• Performing a knee arthroscopy (knee scope) as a clean out procedure for arthritis when no other problems are present like loose bodies or cartilage tears
•   "The current science shows us that just washing out the joint does not decrease the patient's osteoarthritis symptoms and can expose the patient to additional risk," said John Richmond, MD, chair of the AAOS work group.

• AAOS does not recommend for or against:
• Bracing
• Acupuncture
• Hyaluronic acid injections like synvisc or hyalgen

"AAOS Issues New Clinical Practice Guidelines for Osteoarthritis of the

Knee." American Academy of Orthopaedic Surgeons.  11 DEC.  2008 http://www.aaos.org/home.asp.

Can Bone Mineral Density (BMD) Testing Prevent Osteoporosis-Related Fractures?

The National Osteoporosis Foundation Reports:

• Osteoporosis is a major public health threat for an estimated 44 million Americans or 55% of people age 50 or older.
• In the United States 10 million people are estimated to have osteoporosis and 34 million or more are estimated to have low bone mass (increasing their risk for osteoporosis).
• Of the 10 million estimated to have osteoporosis, 8 million are women and 2 million are men.
• 1/2 of women and 1/4 of men over age 50 will have an osteoporosis related fracture .
• Women can lose up to 20% of their bone mass in the 5-7 years following menopause.
• Osteoporosis is often unrecognized in elderly men.

What Can You Do to Prevent Osteoporosis-Related Fractures?

Bone Mineral Density Tests (BMD)

·      Specialized tests that measure bone density in various sites of the body

·      Detect osteoporosis before a fracture occurs

·      Predict chances of future fracture

·      Determine rate of bone loss

·      Monitor effects of treatment by repeating BMD every year

·      BMD is recommended in:

o      Women ages 65 and older

o      Postmenopausal women who have a history of fractures or who have multiple risk factors

o      Men who have certain conditions that are high risk for osteoporosis (like steroid use)

o      Men and women who have been treated for osteoporosis for prolonged periods

·      Increase in BMD testing and osteoporosis treatment is ASSOCIATED WITH A DECREASE IN HIP FRACTURE INCIDENCE!

o      Secondary causes of osteoporosis should be excluded before initiating treatment with common causes being medications and parathyroid and thyroid problems

What Are Other Ways to Prevent Osteoporosis-Related Fractures besides BMD Testing?

• Adequate calcium and vitamin D intake
• Weight-bearing exercise
• Possible biphosphonates (Fosamax, Actonel, Boniva)
• Strategies to reduce falls such as eliminating rugs and using an assistive device such as a cane when outside
• Reduction of risk factors including smoking, low physical activity and poor diet

For more information visit:  www.highmarkbcbs.com.

Black, Judith and Mary Weaver.  "Bone Mineral Density Testing Can

Prevent Osteoporosis-Related Fractures."  Practitioners Journal of Highmark Blue Cross Blue Shield (2008): 24-25.

BACKGROUND INFORMATION:

• Arthritis is one of the most common reasons for disability.
• Primary diagnosis for 430,000 hospital discharges
• $14 billion in hospital charges
• 12.1 % of Americans older than 60 years of age had symptomatic knee osteoarthritis (wear and tear arthritis/most common type)

Johnston County Osteoarthritis Study

This study analyzed the lifetime risk associated with developing osteoarthritis of the knee and hip.  The study was designed to be representative of a civilian English speaking black and white population 45 years or older.  Participants had to be physically and mentally capable of completing the study.

The lifetime risk of developing symptomatic osteoarthritis of the knee by 85-years-old was 44.7%.  There were no significant differences by race, sex and education, but obese participants had a significantly higher lifetime risk (60.5% compared with 30.2% and 46.9% among those who were normal weight and overweight, respectively).   In addition, patients with a history of knee injury had a higher lifetime risk of 56.8% compared to 42.3%. 

Overall, this study demonstrates the high lifetime risk of symptomatic osteoarthritis is likely due to the aging of the population and the alarming rates of obesity.  One in two people is at risk of developing symptomatic knee osteoarthritis and two out of three obese people.  The link of obesity to symptomatic osteoarthritis demonstrates yet another reason to educate the public about weight loss and weight management.  Osteoarthritis is associated with enormous health costs as well as disability.  By educating the public on how to manage or even eliminate obesity and weight issues, we have the potential of decreasing the public health burden of this condition.

Murphey, L.  "Lifetime Risk of Symptomatic Knee Arthritis."  Arthritis and Rheumatism 59 (2008): 1207-1213.

Anthony M. DiGioia III, MD has joined the Wellsphere HealthBlogger Network to share his expertise and links to entries on his blog.

Dr. DiGioia has been selected as an "Everyday Hero" as part of Wellsphere's "Yes, We Care! Campaign."  This program honors those who make extraordinary efforts to help, support and care for others.  As part of this program, you can see Dr. DiGioia and other "Everyday Heroes" on the Map of Caring at www.wellsphere.com/YesWeCare.  If you click this link and scroll about halfway down the page, you will be able to read entries about Dr. DiGioia's work.  The page also features an "Everyday Heroes" video.

Vote now for Dr. DiGioia as the world's best health blogger!  Wellsphere created the first annual "People's Health Blogger Awards" to recognize health bloggers who have made a difference in others' lives.  Voting began on December 15 and will end on January 15.  Go to Dr. DiGioia's Wellsphere page at www.wellsphere.com/Tony-profile/95977, and Click the "Vote for Me" badge to cast your vote.  The winner and the World's Top 100 Health Bloggers will be announced on January 19.

Dr. Tony DiGioia http://www.amd3.org/ROblog/

               Everyday Hero Badge:

Pastor Barbara recently underwent a joint replacement and wanted to share her experience with a video posted on You Tube that is for friends and family members so she can update all on her Journey to Wellness and road to recovery.  The video even shows Pastor Barbara playing a Wii video game (the hula hoop) as part of her post-operative therapy only two days after her surgery.  Dr. Tony DiGioia of Renaissance Orthopaedics performed the surgery as part of the unique Orthopaedic Program at Magee-Womens Hospital of UPMC which is grounded in the principles of Patient and Family Centered Care.

http://www.youtube.com/watch?v=yrMf3StIBXM

RESTLESS LEG SYNDROME (RLS)

What is "restless leg syndrome?"

Restless leg is a neurological disorder in which people feel the urge to move the legs when at rest.  People often describe the sensation as burning, creeping, or pain in the legs, which can range from uncomfortable to extremely painful.  This sensation usually occurs deep inside the leg, between the leg and ankle, and less commonly in the feet, arms, thighs and hands. Because of this sensation to constantly move the legs that does relieve the pain, it is often difficult to sleep and stay asleep, causing extreme daytime fatigue and exhaustion.  The lack of sleep can then cause impaired memory, difficulty concentrating and inability to perform activities of daily living. 

Restless leg syndrome is slightly more common in women and usually occurs in patients middle aged and older.   Events which can trigger restless leg are long car trips, sitting in a movie or any other periods of prolonged inactivity.  In most cases the cause of restless leg syndrome is unknown, but it can be caused by certain medications, chronic medical conditions, pregnancy, and even caffeine, alcohol and tobacco.  Temporary restless leg syndrome can be caused by total joint replacement. 

RESTLESS LEG SYNDROME AFTER TOTAL JOINT REPLACEMENT

After a total joint replacement, patients can often experience a "restless leg-like syndrome."  That is not a true restless leg, but rather a temporary condition resulting from muscle and joint healing as well as the swelling from surgery.  It is more likely to occur after knee replacements, and it can involve a feeling of diffuse pain, calf pain, cramping or the sensation to move leg around.  It is mostly experienced at night and resolves as the muscles and joints heal - approximately 6-10 weeks after the surgery.

TREATMENT OF RESTLESS LEGS SYNDROME

AFTER TOTAL JOINT REPLACEMENT

Treatment of restless leg after total joint replacement involves just moving the leg.  When awakened at night by the sensation, the best thing to do is stretch and walk around.  Also, for most patients the symptoms are less noticeable in the early morning, allowing time to rest.  Decreasing caffeine intake and tobacco and alcohol use can also lessen RLS.  Moderate exercise, regular sleep patterns, ice and massage can help eliminate the urge to move the leg.

·      Walking

·      Exercising or moving your joint, especially at night

·      Stretching

·      Ice and massage

·      Regular sleep patterns

·      Anti-inflammatories or other medications on a case-by case basis

Please keep in mind that restless leg syndrome caused by total joint replacement is a temporary condition and usually will resolve 6-10 weeks after the surgery.