Category Archives: Knee

Considering Injections for Knee Osteoarthritis

kneeDr. Stickney, a Kirkland orthopedic surgeon, is a knee expert specializing in new knee surgery procedures, knee reconstruction surgeryexercise and health, and more.

Recently, the prevalence of knee osteoarthritis (OA) has climbed swiftly because of an increase in human life expectancy, physical activity, and obesity. With knee OA on the rise, doctors are in search of the best treatment for their patients. As a result, interest in intra-articular hyaluronic acid (HA) injections and platelet-rich plasma (PRP) injections has been rapidly increasing. But which treatment is the most effective, if any? A study on injections for knee OA conducted by Kuan-Yu Lin, M.D., Chia-Chi Yang, Ph.D., Chien-Jen Hsu, M.D., Ming-Long Yeh, Ph.D., and Jenn-Huei Renn, M.D., Ph.D. takes a closer look.

The study’s purpose was to prospectively compare the efficacy of intra-articular injections of PRP and HA with a sham control group (using normal saline solution [NS]) for knee OA in a randomized, dose-controlled, placebo-controlled, double-blind, triple-parallel clinical trial.

The clinical trial involved 53 patients with a total of 87 OA knees who were randomly assigned to one of three groups receiving three weekly injections of either 1. Leukocyte-poor PRP (31 OA knees) 2. HA (29 OA knees) or 3. NS (27 OA knees). To analyze the results, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and International Knee Documentation Committee (IKDC) subjective score were utilized and collected at baseline and at one, two, six, and 12 months after treatment.

The results? While all three groups showed statistically significant improvements after one month, only the PRP group reached the minimal clinically important difference in the WOMAC score at every evaluation and the minimal clinically important difference in the IKDC score at six months, while sustaining significant improvement in both the WOMAC score and IKDC score at 12 months. Also interestingly enough, there was no significant difference in the functional outcomes between the HA and NS groups at any point in time.

The most significant finding of this study was that intra-articular injections of leukocyte-poor PRP can in fact provide clinically significant functional improvement for at least one year in patients with mild to moderate osteoarthritis of the knee. If you want to learn more and discuss whether or not PRP injections are the right treatment for you, please contact our office. We’ll help you return to your healthy, pain-free lifestyle.

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. 

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.