Joint preservation

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About joint preservation

Joint preservation techniques are used to repair damaged joints and delay the need for joint replacement surgery. Among the surgical joint preservation procedures are:

  • Knee osteotomy – this is a surgical procedure for patients who have osteoarthritis in just one of the knee compartments. It can help to relieve pain and increase movement in the knee.
  • Cartilage transplant – cartilage grown in the laboratory is used to replace damaged cartilage or the bones are stimulated to promote cartilage growth.
  • Microfracture – using arthroscopy, multiple holes are made in the bone, around 4mm apart. Bone marrow cells and blood then covers the area helping to promote the growth of new tissue.
  • Autologous osteochondral transfer – this involves harvesting bone and cartilage from parts of the knee that bear less weight and transferring this to the damaged area.
  • Autologous chondrocyte implantation – a small piece of articular cartilage is harvested from the patient’s knee and sent to the laboratory to be treated with enzymes to isolate the chondrocytes, which are cells that produce cartilage. These are multiplied and implanted into the patient’s body six to eight weeks later.

There are several non-surgical procedures for relieving pain, including:

  • Corticosteroid injections
  • Injections of hyaluronic acid
  • Platelet-rich plasma injections

Although joint replacement surgery has now become a routine procedure it is still a major operation that carries risks. These risks are higher for people who are overweight, as well as for smokers and people with other health conditions. Sometimes, delaying surgery may be advisable to give people the opportunity to quit smoking, lose weight or stabilise their health. Joint preservation surgery may be recommended as a way of repairing the damaged joint and postponing joint replacement surgery for as long as possible.

In addition, prosthetic implants have a lifespan of around 15 to 20 years so younger patients who undergo joint replacement surgery are more likely to need revision joint replacement, a surgical procedure to replace the worn-out implant. This type of surgery carries an increased risk of complications. Prosthetic implants may also be subject to loosening, stiffness and infection, which can also require surgery.

Joint preservation surgery is used in patients with significant joint pain but who are not yet ready to undergo joint replacement surgery. This may be because they are younger (and so more likely to need revision joint replacement), because they lead an active lifestyle or because they have very localised arthritis.

Joint preservation surgery is carried out arthroscopically (using keyhole surgery).

During a knee osteotomy, a wedge of bone is removed from the upper shinbone or lower thighbone. This shifts the body’s weight off the damaged area of the knee joint and not the opposite side of the knee where cartilage remains intact. Metal plates and screws are used to hold the bones of the knee in their new position. In some cases, a graft of bone may be used to help the osteotomy to heal faster. After the procedure you will normally stay in hospital for one or two days during which time a physical therapist will recommend exercises to help to build strength and flexibility in your knee.

You will normally need crutches for four to six weeks after surgery to keep the weight off your knee as it heals. You may be able introduce low impact exercises such as walking and cycling as your joint heals.

Four to six months after joint preservation surgery you should experience a significant improvement in movement and joint strength. It will allow you to continue to living a normal life by reducing pain to a manageable level and increasing your mobility. You may still need joint replacement surgery but it will enable you to postpone the date of surgery.

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.

The success of a knee osteotomy is determined by a range of factors including how well the cut bone surfaces are able to heal. The bones of smokers have reduced healing ability which can delay the healing process or prevent healing altogether. For this reason, the procedure may not be performed on patients who are active smokers.

Whatever your age, our expertise can help you feel healthy, active and pain-free again.