Tag Archives: hip postoperative rehabilitation

Can Activity Trackers Assist with Recovery After Knee or Hip Arthroplasty?

activitytrackerCommercial wrist-worn activity monitors, like those by Fitbit, the Apple Watch 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 post-operative rehabilitation is a great idea for health and exercise motivation.

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 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 hip or knee 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 for joint replacement postoperative rehabilitation 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!

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 hip and knee surgical 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? Curious about hip or knee postoperative rehabilitation? 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. 

Tips for Running After Hip Replacement

Runners rely on mobility when hitting the track or trail on any given day. Running is a high-impact activity that relies not only on your legs to move, but also your hips; and according to the American College of Sports Medicine, about 500,000 hip replacement surgeries occur yearly in the United States.  Running after Hip Replacement article 3-26-15

According to Dr. Stickney, “The decision on whether to have hip replacement should be a cooperative decision between you, your family and your orthopedic surgeon. After review of your symptoms, x-rays, and your personal expectations, recommendation for surgery is based primarily on the extent of pain and disability, and not on age or necessarily x-ray findings.”

The hip is one of the body’s normal weight-bearing joints made up of a ball and socket frame covered by articular cartilage, lined with synovial membrane that produces the lubricating fluid for movement. Over time, wear and tear of the ball and socket causes the pain and can lead to osteoarthritis and traumatic arthritis.

Running after hip replacement requires hip postoperative rehabilitation, physical therapy and a graduated activity program to avoid stiffness as well as build stamina and strength. Below are some tips on how to build up to your normal running pace:

  • According to the American Academy of Orthopedics (AAOS), start with a slow walking regimen with the aid of a walker, crutches or event trekking poles. These tools will help increase your energy as you continue to heal. Once your surgeon feels that you are ready to put more weight into your step, then and only then, should you increase your walking pace.
  • It is also important to rebuild the muscle strength in your legs by participating in a mild swim exercise with the help of swim fins. Fluid movement in the water minimizes weight-bearing stress to your hip while you are still recovering.
  • A low-impact activity like riding a stationary bike is also a great way to build the muscles in your leg and hip, prevent stiffness and keep it flexible.
  • Lastly, after your walk or run, don’t forget to ice the hip to reduce or prevent inflammation and rest the affected hip.

Dr. Stickney specializes in hip, knee and shoulder surgery in his Kirkland and Redmond locations. If you are a runner considering a hip replacement, contact Dr. Stickney at (425) 823-4000 to schedule an appointment or email him at ProOrthoAppointment@proliancesurgeons.com.   Watch Dr. Stickney’s video and learn more about hip replacement surgery.

 

Hip Replacement – Performing the Anterior Approach

Considering a hip replacement is no easy decision. There are various procedures in the orthopedic marketplace. There are 3 common approaches to the hip replacement. The Posterior Approach is the most common traditional approach. The lateral approach has a lower dislocation risk but a much higher incidence of limp after surgery. I have been performing the anterior approach for total hip replacement for years. In fact, I am the only orthopedic surgeon in Kirkland, WA that performs this procedure.

How does the anterior approach to total hip replacement differ from the traditional hip replacement surgery? For one, the anterior approach is a tissue-sparing alternative. The approach to the hip from the front does not involve cutting any major structures to get to the hip. Instead, the interval between two muscles is separated, leading to the hip capsule. I work between your muscles and tissues without detaching them from either the pelvis or thighbones – sparing the tissue from trauma. The traditional posterior approach from the back requires dividing the gluteus maximus (butt) muscle and splitting part of the ilio-tibial band on the side of the hip and then cutting several small tendons off the back of the hip.

Many surgeons are hesitant to perform the anterior approach because it is new since their training. The special equipment necessary to perform this anterior hip approach has only been popularizer in the past 5 years. This approach is through a much smaller incision and is technically demanding. The anterior approach uses a special table called a Hana table that allows me to position the leg in a very specific way to place the hip components. All of the operating room staff and my assistants are used to doing this hip replacement approach.

Benefits to the anterior approach for hip replacement include:

  • Faster postoperative rehabilitation, recovery time and improved mobility – The muscle tissues are spared during the surgical procedure
  • Less pain – No hip precautions when at home like having to put a pillow between the legs when at rest
  • Limping is eliminated on average 16 days after anterior hip approach vs. 24 days after a posterior approach. Pain relief is faster, 98% of patients are off narcotics 2 weeks after an anterior approach, vs. 70% off narcotics after a posterior approach.
  • Agility – There are no restrictions on hip flexion after an anterior approach.

If you are considering hip replacement and would like more information, please call me at 425-823-400 or email me at ProOrthoAppointment@proliancesurgeons.com to schedule an appointment.