Today's News

Thursday, March 16, 2000

Orthopaedic surgeons seek nonoperative treatment of knee osteoarthritis

Advancements in the nonoperative treatment of knee osteoarthritis, including the use of nutritional supplements, such as shark cartilage, were discussed Wednesday by orthopaedic surgeons at an AAOS Annual Meeting press conference. The clinical syndrome of joint pain and loss of joint function has spawned a variety of possible treatments, but no definitive cures, according to the panel of surgeons.

"It's not a disease that rapidly goes to an end stage joint replacement procedure," said Joseph A. Buckwalter, MD, professor and chair of orthopaedic surgery at the University of Iowa College of Medicine in Iowa City, Iowa. "Roughly 6 percent of the U.S. population has significant knee osteoarthritis, with many million of more patients projected in the future."

The prevalence of knee osteoarthritis increases sharply after age 50, said Dr. Buckwalter, with greater incidences likely to occur among women. Non-operative treatments range from general fitness, physical therapy and hydrotherapy, to a variety of exterior devices, direct fluid injections, acupuncture and prescription drugs.

Perhaps the most popular method has been the introduction of nutritional supplements, such as glucosamine and chondroitin sulfate, to alieviate pain and pressure on the joints. Those claims, however, are anecdotal and are not endorsed by the medical establishment.

"Glucosamine and chondroitin have taken this country by storm," Dr. Buckwalter said. "Most of the patients we have seen are familiar with it, have used it or are planning to use it, despite the lack of conclusive evidence that it works."

An aggressive marketing campaign promoting oral glucosamine and chondroitin sulfate created a strong demand for the supplements, often sold as shark cartilage capsules. Since the products are billed as nutritional supplements, they are not subject to FDA approval. The supplements may claim to treat arthritic joint pain, but cannot claim to cure it, Dr. Buckwalter said. There is no known cure for arthritis.

Robert C. Schenck, Jr., MD, associate professor and deputy department chairman for orthopaedics at the University of Texas Health Science Center in San Antonio, Texas, said the popularity of these supplements is consumer driven.

"Patients love treating themselves," Dr. Schenck said. "According to recent clinical studies, more than 50 percent of the patients who take glucosamine and chondroitin supplements to heal knee joint pain felt they were cured by the supplements. However, there is a significant placebo effect that needs to be taken into account."

Doctors are not certain what the supplements do when taken as oral treatments for knee joint pain. Dr. Schenck said the compounds are theorized to decrease the enzymes that destroy human cartilage and may also produce beneficial proteins, but there is no conclusive evidence for this.

"Most people are using the supplements to treat arthritis, not as a preventive measure or as a cure," Dr. Schenck said. "Glucosamine and chondroitin may be a symptom modifier, but at this point, we don't really know."

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Last modified 16/March/2000 by IS