Category Archives: Joint Replacement

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.

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. 

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.

 

Can Patients Who Live Alone Be Sent Home Safely After Joint Replacement?

homerecoveryAccording to a recent study published by The Journal of Bone & Joint Surgery in partnership with Wolters Kluwer, most patients who live alone can safely be discharged home from the hospital to recover after knee or hip replacement surgery.

This encouraging finding questions the firmly held belief that patients who live on their own should first be sent to an inpatient rehabilitation facility after undergoing joint replacement surgery. “Patients living alone had a safe and manageable recovery when discharged directly home after total joint arthroplasty,” write Andrew N. Fleischman, MD, and colleagues from The Rothman Institute, Thomas Jefferson University, Philadelphia.

The study focused on 769 patients of a similar age demographic who were sent directly home after one-sided total hip or knee replacement; 138 of these patients were living alone for the first two weeks after surgery. The researchers compared complication rates and other important outcomes for patients who lived alone versus those who lived with others.

The researchers did find that patients who lived alone were more likely to spend more than one night in the hospital, had higher rates of in-home nursing care and physical therapy. But otherwise, the outcomes were very similar for patients living alone compared to those who lived with others. In both groups, the post-discharge complication rate was around eight percent. The two groups also had similar rates of “unplanned clinical events,” such as emergency department or urgent care visits. Pain relief and satisfaction scores during recovery were very alike as well.

Perhaps some of the most exciting results: up to six months after surgery, there were no significant differences in scores for joint functioning and quality of life and nearly 90 percent of patients living alone said they would choose to be discharged home directly after surgery again.

Although some patients who live alone can benefit from home health services or even an extra day in the hospital, discharge directly home may be a much more economical and comfortable choice than routinely sending them for inpatient rehabilitation – while also avoiding the believed associated risks.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in exercise and healthjoint replacement surgerysports medicine and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!

Inpatient Compared to Outpatient Joint Replacement

invsoutWith outpatient (same-day discharge) hip and knee replacement procedures becoming more common, it’s crucial to keep up with the latest research. In a recent article published by Journal of Bone & Joint Surgery, Authors Basques, Tetreault and Della Valle conduct a cohort study taking a look at patients who underwent outpatient joint replacement compared to patients who underwent inpatient joint replacement.

The authors researched 177,818 patients who underwent primary elective total hip arthroplasty, total knee arthroplasty or unicompartmental knee arthroplasty from 2005-2014. They found no significant differences in overall postoperative complications or readmission between the inpatient and outpatient procedures, though the study did find that inpatients did have a higher rate of thromboembolic events (blood clots in the legs) and outpatients had a higher rate of reoperation. The researchers also noted that patients with elevated body mass index, (overweight) diabetes and an age over 85 years had an increased risk of readmission rate following outpatient surgery.

In another recent study published by Journal of Bone & Joint Surgery, authors Arshi et al. take a look at the nationwide trends and risks associated with outpatient total knee replacement. The study is a retrospective review of patients who had undergone total knee arthroplasty as either inpatients or outpatients from 2007-2015. The data demonstrated a higher risk of perioperative complications including component failure, surgical site infection, knee stiffness and deep vein thrombosis for outpatients.

This research may seem a bit conflicting, but in the end, it highlights the importance of being in good health before considering outpatient joint replacement surgery. Outpatient joint replacement can be a very successful, cost-saving option, but your orthopedic surgeon should only recommend it if you meet certain health requirements. We work with our patients through all stages of joint replacement to ensure they enjoy a quick, pain-free procedure and recovery and can get back to their healthy lifestyle as soon as possible.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in joint replacement surgerysports medicine and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!

How The SwiftPath Method is Changing Joint Replacement

Joint replacement patients need surgical options that reduce pain, reduce the need for narcotics and speed recovery more than ever. Even patients with severe debilitating arthritis are often afraid of joint replacement — and what they fear most is the pain of the surgery, complications due to using narcotics and being completely out of commission after surgery. The SwiftPath Method aims to resolve all these issues. 

SwiftPath is a protocol-driven company that is constantly striving to discover advanced surgical techniques in joint replacement. Their goal is to collaborate with top surgeons in driving improvements for outpatient and enhanced recovery joint replacements. Over the past two years, the SwiftPath Program has been used in thousands of joint replacements performed across the country. The program is so effective, that many patients can be discharged directly to home with no use of rehabilitation centers, hotels, or other types of recovery settings.

Where traditional joint replacement methods relied on large incisions, heavy doses of pain medications and months of difficult postoperative therapy, new minimally-invasive techniques have advanced joint replacement surgery, now allowing people to get back to their active, healthy lifestyle faster with reduced postoperative pain and stiffness and no need for narcotics. With patient education and family involvement, The SwiftPath Method creates a working plan customized to each patient to cultivate success with outpatient knee replacement. Non-narcotic pain control, streamlined nursing and physical therapy, online home care monitoring and more help patients achieve rapid rehabilitation. These groundbreaking techniques, and much more, are what set The SwiftPath method apart.

Questions about The SwiftPath Method or joint replacement surgeryDr. Stickney, a Kirkland orthopedic surgeon, is an expert in hip replacement surgerysports medicine and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!