Joint Preservation
Joint preservation is the use of non-surgical or surgical means to preserve a deteriorating joint to delay or avoid joint replacement surgery.
Joint preservation procedures reduce the risk of complications from implant surgery and infection.
Joint preservation is a concept of restoring normal and pain-free function to the knee, hip, and shoulder joints. Joint preservation is achieved through the use of multi-modality treatment options that can include activity modifications, physical therapy, medications, injections, and sometimes surgery. Just as every patient is different, each patient’s joint preservation strategy is personalized for his or her age, activity level, expectations, and degree of joint dysfunction.
Elbow Preservation
The elbow connects the upper arm to the forearm with two joints, the humeroulnar joint (which allows the arm to bend) and the radiocapitellar joint (which allows for rotation of the forearm). Strong ligaments, muscles, and tendons work together to provide stability to the joint. Elbow injuries are often caused by overuse and can lead to pain, instability, limited range of motion, and locking of the joint.
Shoulder Joint Preservation
One of the most complex joints in the body, the shoulder joint connects the upper arm bone (humerus) to the shoulder blade (scapula) and provides the flexibility of movement in the arm. While the significant range of motion of the shoulder provides much-needed mobility, it also makes the joint unstable and increases the possibility of injury.
Hand & Wrist Preservation
Through the use of multiple small joints, the hand and wrist play a critical role in performing fine motor activities such as picking up objects, writing, or tying shoelaces. Considering the amount of daily wear and tear on the hands, it’s no surprise that pain is often caused by overuse conditions, such as trigger finger or carpal tunnel, however, sudden injuries are also common.
Hip Joint Preservation
One of the most important joints in the human body, the hip supports body weight and plays a critical role in retaining balance. Connecting the thigh bone to the pelvis, the ball-and-socket construction of the hip joint provides significant strength and flexibility and allows for the wide range of motion required in daily activities.
Knee Joint Preservation
The largest joint in the human body, the knee connects the lower leg and thigh and plays a major role in carrying the body weight in both horizontal and vertical directions. The knee is made up of many important components— including bones, cartilage, ligaments, and tendons—making it susceptible to a variety of injuries.
Foot & Ankle Joint Preservation
The foot and ankle are made up of 31 bones, 33 joints, and more than a hundred muscles, tendons, and ligaments. These structures provide support, balance, and shock absorption when standing, walking, and running.
FAQs
Joint preservation surgery covers a number of treatments that are an alternative option to joint replacement surgery. The aim of joint preservation surgery is to restore functionality to a joint so that it does not have to be replaced, or to delay the need to replace a joint. Joint preservation can be achieved through osteotomies (cuts to the bone) to allow the realignment of the joint.
Treatment options address two important issues biomechanics and biology.
The biomechanics includes knee realignment and ligament reconstructions of the knee. Correction of misalignment improves biomechanics by correcting bowing or knocked knee deformities of the knee and this reduces loads on certain parts of the knee joint reducing pain. The biological forms of treatment are cartilage repair techniques that include Autologous Chondrocyte Implantation (ACI) and osteochondral allograft transplant (OATS).
With the ACI procedure, cartilage cells are harvested from a non-weight bearing area of the knee and grown in a laboratory, and then implanted in the area of the cartilage defect/injury.
With the OATS procedure, autograft cartilage is used and it is obtained from the patient themselves from the non-weight bearing part of the articular cartilage. The allograft can be shaped to fit the cartilage defect and is pressed fit into place.
Ortho-biologics like bone marrow aspiration concentrate(BMAC) and platelet-rich plasma(PRP) are also viable options in the treatment of cartilage defects.
Joint preservation is usually required to address the problems caused by osteoarthritis. Although joint preservation cannot cure arthritis, it can help to relieve pain and discomfort. This form of treatment would be offered to those where non-surgical options have failed. Joint preservation is also more successful in patients who only experience joint pain in certain areas of the joint and the joint as a whole.
During the osteotomy procedure, two small incisions are made, through which a camera is passed to allow the surgeon to assess the damage. An incision is made above the tibia so that the bone can be cut, to allow the realignment of the knee so that the patient’s weight is transferred to the healthier side of the knee joint. The procedure takes up to two hours.
All surgical procedures have risks, including infection, blood clots, and nerve damage. However, the risks associated with joint preservation surgery are significantly lower than the risks of joint replacement surgery.
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