All posts by Dr. Stickney

Home Exercise vs. Outpatient Physical Therapy Following Total Knee Arthroplasty

at-home-exerciseDr. Jeff Stickney, a Kirkland orthopedic surgeon, can help you determine whether outpatient physical therapy or home exercise is better suited for your recovery following total knee arthroplasty. He specializes in orthopedic surgeries and health care including total knee replacement, joint replacement, sports medicine, and more. Contact doctor Stickney’s office today to learn more.

Outpatient physical therapy (OPT) is the practice of visiting a healthcare facility such as a clinic or office to perform exercises to treat musculoskeletal problems. This strategic physical activity with the guidance of a physical therapist is a common means of both injury prevention and recovery from sports injuries, because it helps patients address joint pain and regain range of motion. While OPT has a long history as a fundamental part of proper treatment plans for recovery and maintenance following total knee arthroplasty (TKA), recent studies have questioned the need for OPT following total knee replacement surgery.

A new study, “Home Exercises vs. Outpatient Physical Therapy After Total Knee Arthroplasty: Value and Outcomes Following a Protocol Change”, explored the “health safety, efficacy, and home economics of routine home exercises following TKA compared with OPT immediately afterward”. It compared 251 patients who were prescribed OPT following TKA, and 269 who followed a home exercise program instead after their operations. Ultimately the study found that patients who practice home-directed exercise programs in place of formal OPT have seen comparable outcomes, and can even experience significantly reduced costs. They concluded that while some patients required OPT following their home exercise program, the majority did not.

As the study above highlights, the use of home-healthcare following TKA is increasing. Many other publications have reported the same, claiming that supervised rehab such as OPT may not be necessary for optimal recovery following TKA. However, another recent study explored the association between physical therapy (PT) and functional improvements for patients in home settings. This study also explored factors related to PT utilization, meaning it identified the reasons patients did or did not use their home healthcare.

The study found that lower home-healthcare utilization was correlated with worse recovery. Participation in home-healthcare was generally lower for patients who had the help of physical therapists from rural agencies that came to their home. Medical complexity – such as depressive symptoms or dyspnea – factored into the patients’ levels of participation too.

Comparing the results of both studies, we can conclude that home exercise following TKA is effective, however it’s important that patients actually follow through on utilizing the home practice, performing the necessary amount for an optimal recovery. We can also see that those with medical complexities may need additional monitoring to verify that they perform the necessary amount of home PT sessions to achieve a complete recovery.

Two Habits for Orthopedic Health

sleeping-during-yogaDr. Jeff Stickney, an orthopedic surgeon in Kirkland, is an expert in orthopedic health, modern pain management like the SwiftPath method, sports medicine, and more. Make an appointment with Dr. Stickney to learn how you can return to a pain-free lifestyle.

Prevention is key when it comes to joint pain, sports injuries, neck and back pain, and other complications to your orthopedic health. The best means of prevention is to consistently tend to your overall health, which is often easier said than done. However, maintaining a pain-free lifestyle may be as simple as adding these two healthy habits to your daily routine:

Sleep Evenly
Getting quality sleep is arguably the most crucial aspect of any daily routine, and the most impactful to your orthopedic health. Not only is it the time when your body recovers from activity or injury during the prior days, but it can also determine how your body feels in the days to come. By developing an awareness of your sleeping habits and adapting them, you can prevent waking up with back or neck pain, and set your musculoskeletal system up for pain-free success.

Sleeping on your back is ideal for pain prevention because it avoids any unnatural extension of your spine, while aligning your body from head to toe. This distributes your weight more evenly than sleeping on your stomach, which can exacerbate lower back issues by placing most of your weight on your middle. Stomach sleepers also have a greater chance of a sore neck because your head is twisted to the side. If you can’t sleep unless you’re on your belly, try sleeping with no pillow or a flat one under your head, and another placed beneath your hips.

Side sleepers should aim to keep their neck and spine aligned as much as possible too, and the best way to do so may be by curling both legs toward your chest and placing a pillow between your knees. This arches your back and keeps your hips aligned to prevent any strain on your lower back.

Stretch Regularly
Improving your flexibility and range of motion allows you to perform tasks without joint stress. Try these stretches in the morning to alleviate stiffness, or before you go to bed for a better night’s sleep. Make sure to stay within the limits of your flexibility, and perform static stretching only after a warm up or exercise to avoid injury and get the optimal benefit.

Perform a standing side bend with feet shoulder-width apart, lifting your arms above your head. Move your shoulders as close to your ears as possible and clasp your hands together, as if holding onto a rope from the ceiling. Stretch your spinal cord upward, then lean gently from one side to the other, while maintaining a forward gaze and making sure you don’t lean forward or back. Try holding the stretch on each side for 3-5 breaths to stretch both sides of your body, benefitting your obliques, shoulders, hips, and spine.

The forward fold involves the same stance followed by a bend at the waist, while keeping weight in your heels and allowing your neck and arms to dangle with gravity. This stretches the legs, hamstrings, and back. To target your lower back and hips, try a hip flexor stretch by lying on your back and bringing your knees to your chest. Gently pull the knee towards your shoulder while keeping your spine and the other leg flat on the floor, then repeat on the other side.

By adding regular stretching and quality sleep to your daily routine, along with proper nutrition and exercise, you can rest assured that you’re on the path toward overall orthopedic health, and living your life pain-free. Contact Dr. Stickney to learn more about stretches that are safe for you to perform.

Computer Assisted vs Conventional Total Knee Replacement

doctor-knee-inspectionOsteoarthritis is one of the most common chronic joint conditions, impacting nearly 27 million Americans, with people over 60 generally having some form of the disease. Of the few surgical solutions with long-term benefits, total knee replacement (TKR) is proven to aid with advanced osteoarthritis. However, 20% of patients report continued pain or stiffness in their knees following TKR – preoperative angular deformity from wear and tear can be difficult to correct, and contributes to post-operative symptoms. Computer navigation during surgery has emerged over the past decade as a solution to correct the knee’s alignment, and the implant’s positioning, during TKR. Whether improved alignment leads to better clinical outcomes after TKR or greater implant longevity, is currently a hot topic of debate.

A new study from the Journal of Bone & Joint Surgery compared computer-assisted navigated vs conventional TKR. 190 patients with inflammatory arthritis or osteoarthritis in their knees were randomly assigned to undergo computer-assisted or conventional TKR. The surgeries were performed by eight experienced surgeons, each with more than 100 conventional TKR operations and 10 computer-assisted TKRs. Computer-assisted Knee replacement requires an additional 1 inch incision in the midpart of the tibia, therefore a similar sham incision was performed on patients who received conventional TKR, to blind both patients and observers to the results. The study assessed responders after two years following their surgery to assess alignment, pain levels, implant position and more. This study is the first randomized, double-blinded responder analysis comparing computer-assisted navigated and conventional TKR. It is one of the largest double-blinded randomized controlled trials of its kind.

In theory, better alignment should lead to an improved clinical outcome and an increased long-term survival of the prosthesis. The study notes how positive functional outcomes and “the longevity of total knee prostheses depends mostly on the correct alignment (frontal, sagittal and axial) of the prosthetic components, soft tissue balancing, and restoring the mechanical axis of the lower limb.”

Researchers found that there is, in fact, a difference between the groups at two years. Overall, the computer-assisted TKR group had significantly better clinical results – they were more pain-free and had better function overall compared to the conventional TKR group. This indicates that computer-assistance navigation should also be predictive of a lower rate of revisions and greater longevity of the prosthesis. This study could not prove a causal relationship between good alignment and a positive clinical outcome. Other explanations for the better functional outcome could be that computer navigation might allow the surgeon to achieve more accurate ligament balancing and proper sizing of implant components. This would result in a less extensive impact on soft tissues, as a possible explanation for lower pain.

With significantly more improvement in the computer-assisted group, we can conclude that for at least 2 years after TKR, computer navigation provides patients with better pain relief and function than conventional surgical techniques. These findings have implications at both the individual patient-level and for the health system at large. This is due to economic expenses involved in diagnosing and treating patients with pain after TKA, not to mention the burden it places on individual patients.

The use of computer-assisted navigation in TKR allows for more predictable, accurate, and reproducible restoration of joint alignment, and improved positioning of implanted prosthetic components. This makes it valuable both for surgical training and better outcomes for patients.

Is arthritis or knee pain impacting your life? Dr. Stickney, a Kirkland orthopedic surgeon can help you determine what surgical or non-surgical options are best for you. He specializes in procedures including total knee replacement, joint replacement, sports medicine, and more. Contact his office today to learn more.

 

The Do’s and Don’ts of Supplements and Surgery

stickneysupplementsIf you’re preparing for surgery, you want your body in the best condition for your operation. It’s natural to feel like you need to take every precaution – after all, the success of a procedure depends heavily on preparation and your state of health.

Even though it’s done strategically, your tissue undergoes trauma during surgery. Bones, muscles, cartilage, tendons, and skin endure stress and may experience injury associated with surgery. To avoid complications during the operation and help your body heal, it’s useful to prepare by taking specific supplements and stopping others. Read on to learn what supplements could be beneficial and those that may be worth avoiding:

What Supplements Can You Take to Promote Recovery After Surgery?
Rather than loading up on supplements, the goal is to correct any deficiencies by consuming essential minerals. Consider taking these to keep your body working optimally:

  • Vitamins D, A, and Calcium: Each aid in bone growth and collagen strength.
  • Magnesium: This often deficient mineral ensures proper circulation and heart rate among other benefits.
  • Vitamin C: Supports the immune system as an antioxidant and rebuilds collagen.
  • Zinc: Helps heal wounds and keeps the immune system strong.
  • Probiotics: Replenishes good bacteria and may stave off infection.
  • Ginger: May help keep nausea at bay after surgery.

What Supplements Should You Avoid Before Surgery?
Successful surgery and recovery largely depend on effective blood clotting and rebuilding of collagen, a crucial component of healthy tissue. Platelet aggregation is part of the process that leads to blood coagulation and the release of growth factors needed to start healing. To ensure that these developments occur, it’s best to avoid supplements with platelet inhibiting effects, prior to surgery, like blood-thinners or herbal additives. Some common blood-thinners to watch for are:

  • Gingko Biloba: May lead to excessive bleeding or prevent platelet aggregation.
  • Garlic: Often inhibits platelet aggregation and prevents blood clotting.
  • Ginseng: Can lower blood sugar or increase the risk of bleeding.
  • Ephedra: Might accelerate heart and blood pressure.
  • Vitamin E and Fish Oil: These are slightly more complex. Omega-3 fatty acids and Vitamin E both have been known to act as blood-thinners, but also have shown reductions in inflammation after surgery. In general, the helpful affects here outweigh the potential for blood loss. Consult with an orthopedic surgeon to find out what’s right for you.

After surgery and initial blood loss has ceased, we actually may seek to inhibit blood clot formation to decrease the risk of deep vein thrombosis (otherwise known as a blood clot) that most often occurs in the legs. This type of blood clot is a well-known risk associated with large surgeries and a period of decreased activity. To prevent these clots from forming you may be instructed to take a variety of blood thinners for 2-6 weeks after surgery. The options include:

  • Warfarin: When combined with vitamin K, this blood thinner can inhibit protein synthesis of a factor associated with forming clots. Vitamin K is found primarily in dark green vegetables. If you are placed on Warfarin you will be asked to avoid these vegetables while taking it.
  • Aspirin: While this drug should be avoided prior to surgery, it’s often used after surgery to help prevent blood clots. Aspirin inhibits platelets from coming together and forming a clot.

Another concern is supplements that interact with important drugs administered during surgery. Stay away from calming agents and sedatives, supplements that speed up the body’s breakdown of drugs, or those that elevate the heart rate and blood pressure. A few common types to avoid are:

  • Kava: May prolong effects from sedatives, painkillers, or anesthetics.
  • Milk Thistle: Could weaken the effect of drugs administered during surgery by marginally increasing drug metabolism.
  • Licorice: Can increase blood pressure or cause other nutrient deficiencies.

The type of surgery largely dictates what supplements may or may not be problematic. To confirm that you are taking the correct steps in preparation for surgery, consult with Dr. Stickney,Kirkland orthopedic surgeon who specializes in joint replacement surgery, sports medicine, and more.