Category Archives: Knee

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.

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!

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.