Category Archives: Knee

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.

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!