Category Archives: Knee

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!

The Link Between Distance Running and Arthritis

marathonAlthough distance running is often associated with numerous health benefits, the impact on hip and knee joint health has been inconclusive up to this point. Long-distance running has been linked with an increased prevalence of arthritis in some studies, but others have shown an inverse association or no association at all.

In a recent study published by Journal of Bone & Joint Surgery, authors Ponzio et al. investigate hip and knee health in active marathon runners, including the prevalence of pain, arthritis and arthroplasty and associated risk factors.

To conduct their research, Ponzio et al. distributed a hip and knee health survey internationally to marathon runners from 18-79 years old, divided into subgroups by age, sex BMI and physical activity level. The survey questions assessed pain, personal and family history of arthritis, surgical history, running volume, personal record time, risk factors and current running status. The results were then compared with National Center for Health Statistics’ information for a matched group of the US population who were not marathon runners.

What the authors of the study found is that while age, family history and surgical history independently predicted an increased risk for hip and knee arthritis in active marathoners, there was no correlation with running history. In the researcher’s cohort study, the arthritis rate of active marathoners was below that of the general US population.

While the authors conclude that longitudinal follow-up is needed to determine the effects of marathon running on developing future knee and hip arthritis, it’s a hopeful and encouraging finding for long-distance runners.

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!

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.

Running Might Be Good for Your Knees After All

running-and-kneesOne of the most common myths around running is the toll it can take on your knees as you get older. Both runner and non-runners generally promote the claim that  exercise causes the cartilage around your joints to deteriorate, leading to arthritis and possibly necessitating treatment by an orthopedic surgeon. However, recent research has shown that it can actually be beneficial for your body and joints, warding off arthritis in the future. Researchers from Brigham Young University have found that running changes the joint’s biochemical environment so it functions better, longer.

 Various studies have followed runners throughout lengthy periods of time to determine that they are less likely to develop osteoarthritis than their non-runner peers, but until now, why this is has only been conjecture. Experts speculated this was due to a lower body mass putting less strain on the knees, but little work had been done to isolate the impacts of running on joint health.

The team at BYU studied fifteen male and female volunteers, all of whom were runners, under 30, and had no history of arthritis. The researchers collected a small amount of blood and synovial fluid, a fluid that lubricates joints, from each volunteer — the healthier the joint, the lower the amount of synovial fluid present. They also looked at specific substances within the knee, including cartilage oligomeric matrix protein (COMP), usually a marker of arthritis and present in higher levels in unhealthy knees, and other inflammatory molecules.

The volunteers ran for 30 minutes and sat for the same period, each session occurring on separate days. When the volunteers ran, higher COMP levels were observed in the blood than the synovial fluid, indicating that exercise pushed the substance into their blood and out of the joint. However, when sitting for only 30 minutes, the amount of COMP and inflammatory molecules was raised.

This suggests that even half an hour of exercise alters the knee, lowering inflammation and substances that indicate arthritis. However, sitting for that same amount of time also changes the knee, and not for the better. It could make the joints biochemically more vulnerable to diseases in the future.

The researchers, who published their findings in the European Journal of Applied Physiology, hope to study older or injured runners to see if their knees have fundamental differences from young, healthy joints, and how running might impact them.

Is joint pain impacting your ability to exercise? Interested in learning more about total knee replacement or non-surgical alternatives? Contact Dr. Stickney, a Kirkland orthopedic surgeon, today.

Innovative Developments in Treating Knee Osteoarthritis

stickney-300Knee osteoarthritis is a progressive degenerative condition. Up until recently, all treatments have been directed at ameliorating its symptoms, with no hope of stopping disease progression. However, recent trials using Platelet-Rich Plasma (PRP) to treat the disease, rather than just the symptoms, have had encouraging results. 

PRP is concentrated plasma from your own blood that has been separated to include platelets, small blood cells that are loaded with growth factors responsible for healing cells and that help form clots so your body can repair any damage.  Many of these growth factors have been shown to promote cartilage regeneration. Although PRP has been used since 1987 to help with cell regeneration, using it to stimulate cartilage renewal is fairly new. The treatment entails drawing blood and injecting the PRP into the knee.  

Two recent scientific papers reported decreased pain and improved function after PRP injections. In 2011, the Journal of Arthroscopy reported on the comparative results of injecting knees with PRP versus viscosupplementation with Hyaluronic acid, a procedure that injects a lubricating fluid into the joint. At the six-month follow-up, the PRP group had less pain. A second study in the American Journal of Sports Medicine in 2016 reported on the comparative results of injecting PRP versus saline, which was used as a control. The results of this study showed dramatic improvement at six months in both pain and function for the PRP group. There is much more to learn about PRP injections, and a lot of research is ongoing in this field. 

This data is very encouraging. PRP is readily available, easily processed, safe, and one of the only proven regenerative treatments for early arthritis of the knee.

If you’re suffering from arthritis or are interested in learning more about PRP as a treatment option, contact Dr. Stickney, a Kirkland orthopedic surgeon

First nationwide prevalence study of hip and knee arthroplasty

The orthopedic community and public are well aware that hip and knee replacement operations are among the most commonly performed operations in the U.S. Figures show around 1 million of these procedures are performed each year. But how many people actually are living with a hip or knee replacement in the United States?

This important measure of the impact of joint arthroplasty on public health, known as prevalence, has been missing until the recent release of the Mayo Clinic orthopedics study.