We conducted a cross-sectional observational study among individuals being treated in orthopaedic surgical clinics for osteoarthritis (OA). medication and also taking a CAM that could interact, and 5.9% were taking conventional pain medications along with a CAM that potentially could interact. Orthopaedic cosmetic surgeons should make it portion of their discussion to inquire about CAM use. Level of Evidence: Level III, restorative study. See the Recommendations for Authors for any complete description of levels of evidence. Intro In Canada, arthritis is one of the most common chronic conditions and is a leading cause of pain, physical disability, and use of healthcare solutions [3C6, 24, 30, 36]. There were approximately 58,714 total hip and knee arthroplasties performed in Canada in 2004 representing a 10-yr increase of 87% and a 10% increase compared with 2003 [11]. The number of people with arthritis is definitely expected to boost to 6.5 million by 2031 [5]. The term complementary and alternate medicine (CAM) encompasses many alternative therapies such as dietary supplements, natural herbs, megavitamins, homeopathic medicines, acupuncture, and several additional modalities [17]. The National Centre for Complementary and Alternate Medicine (NCCAM) defines CAMs as a group of medical and healthcare systems, practices, and products that currently are not regarded as portion of standard medicine [33]. CAMs currently are not controlled in North America. In Canada, they may be referred to as natural health products and although they may be in the process of becoming controlled, rules will not be fully completed until 2010 [17]. Similarly, in the United States, CAMs are controlled as dietary supplements by the Food and Drug Administration, a category that does not require proof of safety by the manufacturer before marketing but is not permitted to make treatment-cure statements [44]. A recent study by Health Canada reported 71% of Canadians CPHPC regularly take a natural health product [16]. CAMs can cause potential harmful interactions or side effects with conventional treatments [35, 38, 42, 46]. These include serious complications with anesthesia during surgery [18, 35, 43], an increase or decrease in heart rate and/or blood pressure [25, 26, 32, 34], harmful relationships if used concomitantly with anticoagulant or antiplatelet medications [7, 8, 10, 28, 37, 40], and particular natural medications can create harmful effects in individuals taking NSAIDs or prescription pain medications [20, 21, 43, 45]. Many physicians are poorly educated about alternate therapies [2, 27]. Studies suggest greater than half of orthopaedic cosmetic surgeons are unaware of their individuals CAM use [13, 27], and approximately 60% of individuals who use CAMs do not disclose this information to their main care companies [27, 38]. With the ageing population, the increasing incidence of OA, the use of CAMs with this population, and the potential for severe adverse events when CAMs interact with traditional medications, physicians need to inquire and understand CAMs, to provide optimal patient care. As a result of the increasing prevalence, patient interest, and high risk of adverse effects associated with CAM use, the primary objective of our study was to identify the prevalence of CAM use among patients with OA. The secondary objectives were to assess the level of communication between patients and physicians regarding CAM use, identify reasons for physician disclosure or nondisclosure, and identify any potentially harmful interactions related to CAM use and simultaneous standard therapy. Materials and Methods We conducted a cross-sectional observational study among patients being treated for OA across three university-affiliated orthopaedic surgery clinics in Ontario, during a 1-12 months period (2004C2005). Eligible study participants were at least 16?years of age and able to read and write in English. We excluded patients if they did not have the cognitive capacity to provide consent for participation or were attending the medical center for treatment not related to OA. We designed a survey consisting of closed-ended, multiple-choice, and fill-in-the-blank CPHPC questions (Appendix 1). The questionnaire consisted of five sections: (1) demographic information; (2) general information about the patients OA; (3) prevalence of and reasons for the use of CAMs and amount of money spent each month on CAMs; (4) a detailed list of.If these clots are passed through the heart or to the brain, a heart attack or HD3 stroke may result. or more CAMs, and 40.6% admitted their surgeons were unaware of their alternative therapy use. Reasons for nondisclosure included, the patient thought: (1) it was not important (29.7%); (2) the doctor would not be interested (13.5%); and (3) their doctor would not know about CAMs (8.2%). Twenty-two of 281 patients (7.8%) were taking alternative medicines that could interact with their blood pressure medication, 28.6% were taking anticoagulant/antiplatelet medication and also taking a CAM that could interact, and 5.9% were taking conventional pain medications along with a CAM that potentially could interact. Orthopaedic surgeons should make it a part of their discussion to inquire about CAM use. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for any complete description of levels of evidence. Introduction In Canada, arthritis is one of the most common chronic conditions and is a leading cause of pain, physical disability, and use of healthcare services [3C6, 24, 30, 36]. There were approximately 58,714 total hip and knee arthroplasties performed in Canada in 2004 representing a 10-12 months increase of 87% and a 10% increase compared with 2003 [11]. The number of people with arthritis is expected to increase to 6.5 million by 2031 [5]. The term complementary and alternate medicine (CAM) encompasses many alternative therapies such as dietary supplements, natural herbs, megavitamins, homeopathic medicines, acupuncture, and numerous other modalities [17]. The National Centre for Complementary and Alternate Medicine (NCCAM) defines CAMs as a group of medical and healthcare systems, practices, and products that currently are not considered a part of standard medicine [33]. CAMs currently are not regulated in North America. In Canada, they are referred to as natural health products and although they are in the process of becoming regulated, regulation will not be fully completed until 2010 [17]. Similarly, in the United States, CAMs are regulated as dietary supplements by the CPHPC Food and Drug Administration, a category that does not require proof of safety by the manufacturer before marketing but is not permitted to make treatment-cure claims [44]. A recent study by Health Canada reported 71% of Canadians regularly take a natural health product [16]. CAMs can cause potential harmful interactions or side effects with conventional treatments [35, 38, 42, 46]. These include serious complications with anesthesia during surgery [18, 35, 43], an increase or decrease in heart rate and/or blood pressure [25, 26, 32, 34], harmful interactions if used concomitantly with anticoagulant or antiplatelet medications [7, 8, 10, 28, 37, 40], and certain herbal medications can produce harmful effects in patients taking NSAIDs or prescription pain medications [20, 21, 43, 45]. Many physicians are poorly informed about option therapies [2, 27]. Studies suggest greater than half of orthopaedic surgeons are unaware of their patients CAM use [13, 27], and approximately 60% of patients who use CAMs do not disclose this information to their main care providers [27, 38]. With the aging population, the increasing incidence of OA, the use of CAMs in this population, and the potential for severe adverse events when CAMs interact with traditional medications, physicians need to inquire and understand CAMs, to provide optimal patient care. As a result of the increasing prevalence, patient interest, and high risk of adverse effects associated with CAM use, the primary objective of our study was to identify the prevalence of CAM use among patients with OA. The secondary objectives were to assess the level of communication between patients and physicians regarding CAM use, identify reasons for physician disclosure or nondisclosure, and identify any potentially harmful interactions related to CAM use and simultaneous standard therapy. Materials and Methods We conducted a cross-sectional observational study among patients being treated for OA across three university-affiliated orthopaedic surgery clinics in Ontario, during a 1-12 months period (2004C2005). Eligible study participants were at least 16?years of age and able to read and write in English. We excluded patients if they did not have the cognitive capacity to provide consent for participation or were attending the medical center for treatment not related to OA. We designed a survey consisting of closed-ended, multiple-choice, and fill-in-the-blank questions (Appendix 1). The questionnaire consisted of five sections: (1) demographic information; (2) general information about the patients OA; (3) prevalence of and reasons for the use of CAMs and amount of money spent each month on CAMs; (4) a detailed list of the patients prescription medications; and (5) detailed information regarding the patients OA (this section completed by the orthopaedic doctor). Questionnaire items were generated by critiquing the literature, searching naturopathy and holistic Internet web sites, and contacting experts in naturopathy, alternative medication, and orthopaedic medical procedures. We used an example to redundancy technique where we contacted specialists until no fresh products for the questionnaire surfaced. We pretested the questionnaire with an unbiased band of 10 community people and three orthopaedic cosmetic surgeons to ascertain.