All posts by Dr. Stickney

Considering Injections for Knee Osteoarthritis

kneeDr. Stickney, a Kirkland orthopedic surgeon, is a knee expert specializing in new knee surgery procedures, knee reconstruction surgeryexercise and health, and more.

Recently, the prevalence of knee osteoarthritis (OA) has climbed swiftly because of an increase in human life expectancy, physical activity, and obesity. With knee OA on the rise, doctors are in search of the best treatment for their patients. As a result, interest in intra-articular hyaluronic acid (HA) injections and platelet-rich plasma (PRP) injections has been rapidly increasing. But which treatment is the most effective, if any? A study on injections for knee OA conducted by Kuan-Yu Lin, M.D., Chia-Chi Yang, Ph.D., Chien-Jen Hsu, M.D., Ming-Long Yeh, Ph.D., and Jenn-Huei Renn, M.D., Ph.D. takes a closer look.

The study’s purpose was to prospectively compare the efficacy of intra-articular injections of PRP and HA with a sham control group (using normal saline solution [NS]) for knee OA in a randomized, dose-controlled, placebo-controlled, double-blind, triple-parallel clinical trial.

The clinical trial involved 53 patients with a total of 87 OA knees who were randomly assigned to one of three groups receiving three weekly injections of either 1. Leukocyte-poor PRP (31 OA knees) 2. HA (29 OA knees) or 3. NS (27 OA knees). To analyze the results, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and International Knee Documentation Committee (IKDC) subjective score were utilized and collected at baseline and at one, two, six, and 12 months after treatment.

The results? While all three groups showed statistically significant improvements after one month, only the PRP group reached the minimal clinically important difference in the WOMAC score at every evaluation and the minimal clinically important difference in the IKDC score at six months, while sustaining significant improvement in both the WOMAC score and IKDC score at 12 months. Also interestingly enough, there was no significant difference in the functional outcomes between the HA and NS groups at any point in time.

The most significant finding of this study was that intra-articular injections of leukocyte-poor PRP can in fact provide clinically significant functional improvement for at least one year in patients with mild to moderate osteoarthritis of the knee. If you want to learn more and discuss whether or not PRP injections are the right treatment for you, please contact our office. We’ll help you return to your healthy, pain-free lifestyle.

A New Chapter in Knee Implants

kneeappointmentDr. Stickney, a Kirkland orthopedic surgeon, is a knee expert specializing in new knee surgery procedures, knee reconstruction surgery, sports medicine, and more.

New developments in biomedical engineering and robotics have recently opened a new chapter in high-performance knee implants with the creation of the JOURNEY II XR Active Knee System, which combines an implant designed to restore the stability and natural motion of the human knee with low-friction materials that may help extend the longevity of the implant itself. We are proud to be offering this new product to our patients.

Conventional Knee Implants
All knee implants are faced with the challenge of mimicking the normal swing-and-rotate motion of the knee while making sure the joint remains stable and has durability after surgery. Conventional knee implants have attempted to recreate this natural, fluid motion of the knee with a rotating platform or plastic insert design that allows flex and rotation. Unfortunately, both of these options force the muscles around the patient’s joint to work harder as they adjust to the joint’s new pattern of movement. The anterior cruciate ligament and sometimes the posterior cruciate ligaments are removed with conventional Knee designs. These ligaments aid in position sense or proprioception. There have been many different designs of the plastic insert to replicate the function of these ligaments. The JOURNEY II XR is designed to keep the ligaments and build the knee around them. This does make the technical aspect of inserting the knee more complicated. It will also provide a much more natural feeling knee with activity.

The JOURNEY II XR Knee Implant pays attention to anatomical detail, more accurately replicating the true anatomy of the knee. With an anatomically molded femoral component (bottom of the thigh bone) and two plastic inserts, the JOURNEY II XR active knee system recreates the knee’s original shape and range of motion, preventing surrounding muscles and other tissue from straining to compensate for unfamiliar stress. A U-shaped tibial base plate (top of the shin bone in the lower leg) fits around the healthy ACL and PCL, allowing them to function as they normally would rather than being removed.

Knee surgery patients with the JOURNEY II XR total knee system will likely feel less of a difference from a normal healthy knee, and greater stability. The end result may be a quicker recovery, better function, and greater satisfaction. While some may benefit, not all patients qualify for the JOURNEY II XR Knee implant. For instance, many people have ruptured their anterior cruciate ligament in their lifetime, or have developed significant angular contraction of ligaments around the knee and the JOURNEY II XR would not be appropriate in these patients. Please consult with orthopedic expert Dr. Stickney to evaluate your condition and implant options.

Hamstring Injuries: Risks, Treatment, and Rehab

hamstringDr. Stickney, a Kirkland orthopedic surgeon, is a sports medicine expert specializing in hamstring injuries, pitching shoulder injuries, Swiftpath knee surgery, and more.

Hamstring injuries are common among individuals with an active lifestyle, especially for athletes in sports that involve high speed running or kicking. Sports like track-and-field, soccer, dancing, football, long-distance running, and water-skiing all have a heightened risk for hamstring issues. Erratic contraction of the hamstrings while running at high speeds, quick-burst movements, and sudden trauma are believed to cause these injuries.

Three muscles make up the hamstring (semitendinosus, semimembranosus, biceps femoris), starting from the bottom of the pelvis (ischial tuberosity) down to the knee joint where the muscles connect with tendons to attach to the bones. Your hamstrings allow you to bend your knee and help with hip extension, though this is primarily done by the gluteus Maximus.

There are two prominent types of hamstring injuries – tears to the muscle belly (the thick part of the muscle or where muscle fibers join tendon fibers) and acute avulsions to the tendon (when the tendon completely tears away from the bone). The sciatic nerve running from the lower back down the back of the legs may also be compromised during hamstring trauma, due to its proximity.

Injuries arising from a single abrupt trauma rather than from smaller cumulative injuries tend to be more serious and affect younger patients (age < 25). However, with increasing age the likelihood of injury increases. The risk factors associated with this injury include, the type of sport, poor flexibility, asymmetric strength, and above all prior injury.

With so many variables to consider, how do you prevent hamstring injuries? What are the most important risks to be aware of, how should you treat a hamstring injury, and what is the best way to recover?

A review titled “Hamstring Injuries – Risk Factors, Treatment, and Rehabilitation” published by the Journal of Bone and Joint Surgery evaluated 9 different contemporary studies exploring predictive factors, diagnosis strategies, treatment methods, and recovery techniques for hamstring injuries. The studies involved varying sample sizes and methodologies tailored to their respective topics.

The findings:

  • The most predictive factor for a hamstring injury is any previous hamstring injury including sprains, tears, and avulsions. When a patient has a history of hamstring injuries, they’re also likely to have a longer recovery time – especially recreational athletes compared to professionals. The importance of early intervention cannot be overstated; one of the major reasons rec athlete’s recovery time is longer than the pros is because they prolong their first consultation and treatment. If you may have experienced hamstring injury, contact a sports medicine expert
  • MRI (magnetic resonance imaging) edges out ultrasound as the best means of evaluating the extent of a hamstring injury and whether surgical intervention is warranted.
  • Muscle belly tears are often better treated with conservative treatment, whereas hamstring avulsions may be better treated with surgery depending on the displacement of the tendon.
  • Conservative treatments such as RICE (rest, ice, compression, elevation), nonsteroidal injections (anti-inflammatory drugs), physical therapy, stretching, PRP (Platelet Rich Plasma) injections, and corticosteroid injections are indicated for acute hamstring strains, partial tears, and single-tendon avulsions. PRP injections combined with rehab exercises for hamstring injury, like physical therapy, is more effective than rehab exercises alone.
  • Surgical repair of complete proximal hamstring ruptures, both acute and chronic, results in improved outcomes compared with nonoperative management.
  • Repair of acute proximal hamstring tendon tears results in better functional outcomes than repair of chronic tears. Again, how long a hamstring injury takes to heal and the effectiveness of recovery depends on early intervention.
  • Stretching and strengthening the hamstring tendons with eccentric exercise is helpful in conjunction with physical therapy after injury. Strengthening, Stretching, control of early inflammation, and massage of scar tissue all may reduce the risk of re-injury, or may prevent hamstring injuries altogether.

Having a better understanding of hamstring injuries allows clinicians to provide better treatment and patients to manage their injury most effectively. If you have questions regarding hamstring injuries or would like to schedule an appointment, contact our sports injury clinic.

Is Physical Therapy Effective After Rotator Cuff Tear?

shoulderptDr. Stickney, a Kirkland orthopedic surgeon, is an expert in shoulder injury treatment, total and partial knee arthroplasty, sports medicine, and more. 

Rotator cuff tears are extremely common, affecting at least 10% of people over the age of 60 in the United States – which equates to over 5.7 million individuals. Of the 5.7 million+ individuals who suffer from rotator cuff tears, fewer than 5% are treated surgically, and patients who undergo surgical repair experience a failure rate between 25 and 90%. What’s interesting though, is that patients with repair failures report satisfaction levels and outcome scores that are nearly indistinguishable from those whose repairs are intact. Because most of these surgical patients undergo postoperative physical therapy, it is logical to assume that physical therapy may be responsible for the improvements in outcome. A multicenter prospective cohort study conducted by the MOON Shoulder Group and published by Journal of Shoulder and Elbow Surgery takes a closer look.

To conduct the study, 452 patients with atraumatic full-thickness rotator cuff tears provided data via questionnaire on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments. Physicians also recorded physical examination and imaging data. Patients then began a physical therapy program developed from a systematic review of the literature and returned for evaluation at six and 12 weeks.

At those visits, patients could choose one of three courses: 1. Cured (no formal follow-up scheduled), 2. Improved (continue therapy with scheduled reassessment in six weeks), or 3. No Better (surgery offered). Patients were also contacted by telephone at one and two years to determine whether they had undergone surgery since their last visit and a Wilcoxon-signed rank test with continuity correction was used to compare initial, six-week, and 12-week outcome scores.

The results? Patient-reported outcomes improved significantly at six and 12 weeks and patients elected to undergo surgery less than 25% of the time. The patients who did end up deciding to have surgery generally did so between six and 12 weeks, and few had surgery between three and 24 months.

This study suggests that nonoperative treatment using this physical therapy protocol is indeed effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for two years.

If you have questions about treatment options for your shoulder injury or would like to make an appointment, please contact our office.

Should You Consider Partial Knee Replacement?

kneeA partial knee replacement, also known as unicompartmental knee arthroplasty (UKA), can be a very appealing alternative to a total knee replacement for those suffering from severe knee pain. UKA is less-invasive, more cost-effective, promises the preservation of important bone, ligaments, and knee function, and provides an enhanced postoperative recovery. But is it the right procedure for you? The Medial Unicompartmental Arthroplasty of the Knee article by Jennings, J. M., Kleeman-Forsthuber, L. T., and Bolognesi, M. P. takes a closer look.

In years past, isolated anteromedial osteoarthritis or spontaneous osteonecrosis of the knee were the only primary indications for partial knee replacement. Patients needed to be under age 60, less than 180 pounds, avoiding heavy labor, and experiencing minimal baseline pain, among other restrictions, which left only 6% of patients meeting all parameters.

Over the last two decades, however, studies have shown that the traditional indications for UKA can be expanded significantly with excellent results still obtained. Focused preoperative examination and imaging are needed to identify appropriate surgical candidates, but once selected, patients who undergo UKA experience faster recovery, improved kinematics, and better functional outcomes compared with total knee replacement, also known as total knee arthroplasty (TKA).

What’s more, the ten-year survival rates for partial knee replacement in cohort studies have shown to be greater than 90% with outcomes after conversion to total knee replacement being very similar to outcomes for revision TKA. While this information is encouraging, survivorship data should continue to be scrutinized and take both patient factors and functional outcomes into careful consideration.

As more long-term data on partial knee replacement becomes available, it will further guide clinicians in counseling patients on whether UKA is the right procedure for them. When performed at high-volume centers with advanced surgical techniques and on the correct patient populations, partial knee replacement has the potential to be a great alternative to total knee replacement.

If you want to learn more and discuss whether or not UKA is the right procedure for you, please contact our office. We’ll help you return to your healthy, pain-free lifestyle.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in total and partial knee arthroplasty, exercise and health, and more. 

Is Yoga Safe After Joint Replacement Surgery?

yogaIf you’re one of the 35 million people in the US practicing yoga, you may be wondering if you can return to your practice after joint replacement surgery. Or maybe you’ve heard about the benefits of yoga and are interested in starting it up postoperatively. But is yoga safe and recommended for your new joint? Carried out with awareness of your limitations after surgery, yoga can be a very useful tool in the rehabilitation process.

Physical activity, including yoga, is an important part of recovery after joint replacement surgery. It helps to restore function and mobility in your joint, ease pain and swelling, and more. Yoga, specifically, helps to strengthen the muscles surrounding your new joint, increase flexibility, reduce stress, and can help you become more aware of your body’s alignment and posture.

Consult with Your Orthopedic Surgeon First. Remember, your situation is unique to you, and no one knows the condition of your new joint better than your orthopedic surgeon. Whether or not your orthopedic doctor recommends yoga can depend on how your joint replacement surgery went, how your recovery is expected to go, and what kind of restrictions you may have. For example an anterior hip replacement would allow for unrestricted yoga a few months after surgery. However a posterior approach hip replacement would require restrictions that would limit flexion poses like down dog child’s pose. It’s extremely important to consult with your orthopedic doctor before starting any type of physical activity, including yoga.

Talk to Your Yoga Instructor. If your orthopedic doctor gives you the go-ahead, it’s wise to also talk with your yoga instructor(s). Qualified instructors will know about the anatomy and movement of the hip and knee. They should be able to give you advice on what poses and movements will be beneficial, and what poses and movements you may need to avoid, either permanently or just while you heal. Modifications will most likely be necessary for a safe postoperative yoga practice. Your instructor can also help you correct your alignment to stay safe and provide help with any props.

Choose the Right Practice Style. Early on in the recovery, a restorative yoga class may be beneficial. Restorative yoga classes are typically slow and gentle, use a lot of helpful props, and focus on relaxation. Once you receive an okay from your orthopedic doctor to do so, any style of yoga, including Vinyasa or Bikram yoga, is possible as long as proper modifications are made to your practice.

Trust Yourself. After joint replacement surgery, it’s even more important to listen to your body’s cues while practicing yoga to maintain proper alignment and protect your joint replacement. Remember, never force yourself into a pose that’s painful or feels wrong.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in total knee arthroplasty, total hip arthroplasty, exercise and health, and more. Contact Dr. Stickney to return to your healthy, pain-free lifestyle.