All posts by Dr. Stickney

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 for 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 health, 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.

Meniscectomy Biomechanics and Clinical Outcomes

Stickney_kneeThough the meniscus is just a small part of the knee, it plays a very important biomechanical role in regular knee function including load bearing, shock absorption, and joint stability. Unfortunately, meniscus tears are one of the most common injuries orthopedic surgeons encounter, and thus, partial meniscectomy is one of the most common procedures performed.

But not all tears require surgery. In fact, according to Biomechanics and Clinical Outcomes of Partial Meniscectomy by Freeley, Briant T., MD; Lau, Brian C. MD published in Journal of the American Academy of Orthopaedic Surgeons, an MRI study found that 61% of aging asymptomatic patients had a meniscus tear identified on imaging.

Because orthopedic physicians must identify patients who will likely benefit from a partial meniscectomy, it’s vital that they understand the biomechanical implications and clinical outcomes of partial meniscectomy. As a patient, it’s always best to be educated on the latest research as well, so you can be an advocate for your own health.

For cases that do require partial meniscectomies, there has been extensive research conducted evaluating the biomechanical consequences and clinical outcomes. It was found that as the portion of the meniscus that is removed increases, the greater the contact pressure experienced by the Articular cartilage attached to the bone. This can lead to altered knee mechanics and early cartilage wear. However; leaving a mobile meniscus tear un treated in an otherwise healthy knee, which is creating mechanical symptoms of popping or locking, can result in further tearing of the meniscus and early wear of the cartilage above and below the tear. This leads to early arthritis.

It’s important to note that the use of partial meniscectomy to manage degenerative meniscus tears in knees with mild preexisting arthritis and mechanical symptoms can be beneficial; however, its routine use in the degenerative, arthritic knees is not likely to provide long term benefit. Physical therapy may be more successful in this situation . In younger age groups, partial meniscectomies may provide long-term symptom relief, earlier return to activity, and lower revision surgery rate compared with meniscal repair. If a large peripheral tear in the vascular part of the meniscus is present in a young person this would be where meniscal repair can result in a near normal knee long term.

Perhaps the most valuable takeaway from this biomechanical study is a greater understanding of the implications of meniscectomy. Orthopedic surgeons must subscribe to the current principle of maintaining as much meniscal tissue as possible. Partial meniscectomy remains a mainstay of treatment for unstable, central meniscus tears and offers favorable clinical outcomes with a low risk to patients when done correctly. Treatment should always be patient specific in a shared decision-making process with the patient.

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.

Can Activity Trackers Assist with Recovery After Knee or Hip Arthroplasty?

activitytrackerCommercial wrist-worn activity monitors, like those by Fitbit or Garmin, have the potential to accurately assess activity levels and have been gaining popularity in the last few years. In a 2018 study published in The Journal of Arthroplasty, researchers set out to determine if feedback from activity monitors can improve activity levels after total hip arthroplasty or total knee arthroplasty.

To conduct this study, 163 people undergoing primary total knee arthroplasty or total hip arthroplasty were randomized into two groups. Subjects in the study received an activity tracker with the step display obscured two weeks before surgery and completed patient-reported outcome measures. On the day after surgery, participants were randomized into either the “feedback group” or the “no feedback group”. The feedback group was able to view their daily step count and was given a daily step goal. Those in the no feedback group wore the device with the display obscured for two weeks after surgery and did not receive a formal step goal, but were also able to see their daily step count after those two weeks were up.

Average steps taken by both groups were monitored at one, two, and six weeks, and again at six months. At six months after surgery, subjects repeated their patient-reported outcome measures.

It turns out that the feedback group subjects had a significantly higher average daily step count by 43% in week one, 33% in week two, 21% in week six, and 17% at six months, compared to the no feedback group. Additionally, the feedback group subjects were 1.7 times more likely to achieve an average of 7,000 steps per day than the no feedback group subjects at six weeks after surgery. Six weeks after surgery, the feedback group participants were back to their pre-op activity levels (100%) and at six months, they were actually stepping more (137%). While 83% of the no feedback group participants reported they were satisfied with the results of the surgery, 90% of the feedback groups reported the same.

With mobility and physical activity being imperative to healthy aging and very helpful for recovery after total hip arthroplasty or total knee arthroplasty, incorporating an activity monitor into your after-surgery-care checklist is a great idea.

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.

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.