Category Archives: Joint Replacement

Staph Infection Heightens Risk of Surgical Complications

staph-infectionInfection after joint replacement surgery is a terrible complication that often results in subsequent surgeries with extended morbidity and rehabilitation. The possibility of infection after joint replacement depends to some degree on the patient’s immune capabilities, with the incidence ranging from 1.5 to-6% over a lifetime.

One of the leading pre-operative risk factors in orthopedic patients is the presence of Staphylococcus aureus (S. aureus), or staph, on the skin or nasal cavity. Most postoperative infections after joint replacement are the result of bacteria from the patient’s skin falling into the wound during surgery. In most cases, the immune system is able to eliminate those bacteria, but staph carriers are two to ten times more likely to face infection.

Pre-operative skin washing at home, skin scrubbing in the operating room, and intraoperative surgical irrigation and antibiotics help minimize this risk. Patients with staph chronically growing on their skin are at higher risk due to the aggressive nature of this bacteria and the heightened risk of wound infection. On average, 18-25% of patients will have staph on their skin chronically, and of this group, approximately 11% have a strain resistant to antibiotics.

A recent study done at NYU Langone Medical Center analyzed 13,828 orthopedic patients between 2009 and 2016. In this study, patients were tested preoperatively for the presence of S. aureus, with 18% testing positive for colonization. The researchers also found that 4.35% of the colonized patients developed surgical site infections (SSIs) after surgery while only 2.39% of non-colonized patient’s developed SSIs postoperatively. Specifically, patients who had undergone total knee replacement surgeries were 380% more likely to develop a postoperative infection if the patient was colonized with S. aureus prior to the procedure.

This information points to the importance of understanding who is at higher risk of a post-operative infection. Developing methods to minimize this prior to surgery also helps combat readmission, revision surgery, longer hospital stays, and increased medical bills.

Questions about joint replacement surgery? Concerned about your orthopedic health or interested in taking steps to protect it in the future? Dr. Stickney is a Kirkland orthopedic surgeon who can help find the best surgical and nonsurgical options for you. Contact his office for an appointment today.

Smoking Increases Risk of Postoperative Complications

smoking-surgical-riskThe adverse effects of smoking upon a patient’s health have been known for decades. However, the relationship between smoking and postoperative complications for total joint arthroplasty has, until recently, been unclear. As total joint arthroplasty, a treatment for degenerative joint disease, is expected to increase in frequency in the United States, the medical community has been interested in potential risk factors, such as smoking. A recent study performed at The Rothman Institute at Thomas Jefferson University has found definitive evidence that current smokers, as well as former smokers, are at significantly higher risk of postoperative complications after joint replacement than non-smokers.

This recent research, published in The Journal of Bone and Joint Surgery, Inc, studied 15,264 patients who underwent 17,394 total joint arthroplasties between 2000 and 2014. The team sought to determine if smoking impacted whether or not a patient faced readmission and/or reoperation within 90 days of the first surgery.

Of the patients surveyed, 9% currently smoked, 34% had formerly smoked (on average, they had quit 22 years before), and 57% were nonsmokers. While the average age of the latter group was 63.2 years, current smokers needed surgery at an average of 57.7 years. The researchers also analyzed packs smoked per decades — an average of 233 for current smokers and 221.1 for former smokers.

The researchers’ findings show current smokers were much more likely to need reoperation for infection within 90 days of the original procedure. Smoking, regardless of current status, also led to significantly higher rates of unplanned nonoperative readmission. The more packs smoked per decade, the more these potential complications increased.

Tobacco use is the largest preventable cause of disease and death, triggering complications and risks even after a user has quit. Knowing the dangers is crucial to leading a healthy life, whether now or several decades later, especially given its relationship to surgery outcome. It is likely insurance and medical practices may require smoking cessation prior to joint replacement surgery in the future.

Troubled by joint pain? Concerned about how smoking might be impacting your joints or joint surgery? Dr. Stickney, a Kirkland orthopedic surgeon, specializes in procedures including total knee replacement and shoulder replacement. Contact his office today to return to a healthy, active lifestyle. 

PRP Injections May Be the Answer to Osteoarthritis

PRP-and-the-kneeAlthough osteoarthritis is one of the most common chronic joint conditions, few nonsurgical options have shown long-term benefits. Impacting almost 27 million Americans, the disease causes pain, swelling, and mobility issues as the cartilage between joints wears down. Joint replacement surgery can provide relief once the disease has significantly progressed, but nonsurgical alternatives have only had short-term benefits. Now, a new study published in The Journal of Arthroscopic and Related Surgery suggests that Platelet-Rich Plasma (PRP) injections could combat pain and improve joint functioning in the knee.

In the past, nonsurgical treatments have included using anti-inflammatory drugs and corticosteroid and hyaluronic acid (HA) injections. While they ease discomfort, research hasn’t found that the conditions are improved over a longer length of time, necessitating total knee replacement surgery. PRP, however, might offer a new solution.

PRP is blood plasma infused with platelets and contains several different growth factors. It’s been used to help alleviate pain from damaged muscles, ligaments, tendons, and joints by healing damaged cells and promote formation of cartilage repair tissue. Until now, no tests about its efficacy have been conclusive, partly due to small sample sizes. To make a more definitive claim, researchers from The First Affiliated Hospital of Chongqing Medical University conducted 10 randomized controlled trails with 1,069 patients.

562 patients received PRP injections to their knees, 429 received HA injections, and 78 received saline injections. Studies had three month, six month, and 12 month follow-ups. Although at six months, relevant studies showed no difference in pain or function scores, at one year, the researchers found that PRP was significantly more effective than HA at relieving pain and improving function.

Researchers were concerned that the proinflammatory substances PRP releases could be detrimental to tissues. However, no tissue damage was reported at either the six or 12 month follow-up and there were no differences in adverse effects between PRP and HA. More research will be needed before this can be confirmed.

Overall, these results show that PRP could be a viable nonsurgical option for patients with OA, helping regenerate tissue and stimulate HA production over a longer period of time.

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

Does Timing for Total Joint Surgery Matter?

TJA-importanceWhile choosing whether or not to get total joint arthroplasty (TJA) can be a difficult and daunting decision, new research shows that delaying it may have a negative impact on postoperative outcomes. Carlos J. Lavernia, MD, who helmed a study evaluating pre- and postoperative functioning, presented his findings at the American Association of Hip and Knee Surgeons’ (AAHKS) annual meeting.

Previously, Dr. Lavernia had studied TJA patients and found those with lower preoperative functioning had worse short-term self-reported outcomes after surgery than their higher preoperative functioning peers. Interested in examining the long-term impacts, Dr. Lavernia and his team looked at 105 patients from the original group and split them into those who were severely functionally impaired versus those who were functionally impaired. The demographics for both groups were very similar, though the first was 40% female and the latter was 73.8% female.

The patients had an average age of 65 years and 54 had total hip arthroplasties while 51 had total knee arthroplasties. The mean follow-up period for all patients was 11.2 years, 13 had revision surgery, and 43 passed away. However, there did not seem to be significant differences in revision or mortality statistics between the severely functionally impaired and functionally impaired groups.

The research team calculated scores using the Western Ontario and McMaster Osteoarthritis Index, Short Form 36, and the Quality of Well Being Scale both pre- and post-operation. They found that while all scores improved after surgery, those who had lower preoperative scores continued to have worse outcomes after the arthroplasty.

“We found that those who allowed their function to deteriorate significantly before undergoing TJA did not fully ‘catch up’ to patients who underwent surgery at an earlier disease stage,” Dr. Lavernia said.

This research emphasizes the importance of undergoing TJA earlier rather than later and treating the disease as early in its course as possible. Consulting an orthopedic surgeon can help you determine if surgery may be the appropriate intervention.

Concerned about joint pain? Wondering if orthopedic surgery is the right choice for you? Dr. Stickney is a Kirkland orthopedic surgeon who can help you return to an active, healthy lifestyle. Contact his office today at 425.823.4000 to learn about the surgical and nonsurgical options best for you. 

The Link Between Gum Disease and RA

 gum-disease-RAWhen your dentist reminds you to floss, they may be improving your orthopedic well being, along with your oral health. New research published in Science Translational Medicine discovered that the bacteria behind gum disease could also be the catalyst behind rheumatoid arthritis (RA). Although about 1.3 to 1.5 million Americans suffer from RA, an autoimmune condition which causes inflammation, swelling, pain, and stiffness in the joints and can necessitate joint replacement surgery, the root cause is unknown.

The relationship between gum disease and RA has been explored in the past. In 2008, a German study that appeared in the Journal of Periodontology found that people with RA are eight times more likely to develop gum disease than people without RA. In 2012, researchers discovered a correlation between tooth loss and joint inflammation — the greater the tooth loss, the greater the joint inflammation. Various other studies looked at different types of bacteria, such as that responsible for periodontal disease, to try and find a connection, though this research probes further at what specific strain of bacteria could link the two issues.

An international group of researchers collected blood samples from 100 people with gum disease and 100 people with healthy gums to study the bacteria at play. They also gathered blood and joint fluid samples from over 200 people who met RA’s disease criteria, and fluid from between the gum and teeth from nine people with periodontitis and eight people without. By testing and comparing the samples, the researchers noted that those with gum disease had higher levels of citrullinated proteins in their gum fluid than normal. While citrullination is a natural protein regulatory process, the scientists discovered that a strain of bacteria called Aggregatibacter actinomycetemcomitans was responsible as it produces a toxin that splits open certain cells, releasing citrullinated proteins.

The immune system in patients with RA reacts to this by creating antibodies specifically designed to combat the toxin, suggesting that the bacteria could trigger the autoimmunity of RA. While more research is needed to find a definitive correlation, researchers from Case Western University noticed that patients with RA saw a decrease in pain and other arthritis symptoms when they treated their gum disease.

This still doesn’t provide an exact answer of what can cause RA, nor does it prove gum disease is the main culprit since the presence of one doesn’t necessarily guarantee the other. As the disease’s onset can take decades, it’s possible there are other inflammatory processes at play and poor brushing habits can’t be blamed entirely. However, these findings provide new understanding of how the disease works and interacts with other bodily systems.

If you’re suffering from joint paint, contact Dr. Stickney, a Kirkland orthopedic surgeon who specializes in procedures including total knee replacement and knee arthroscopy surgeries.