Joint Preservation Patients May Be Able to Avoid Joint Replacement

When Olympic champion Lindsey Vonn announced her return to World Cup skiing recently, she credited the comeback to knee replacement surgery earlier this year. Repeated injuries made a knee replacement the best option for the 40-year-old, but for many younger patients suffering with chronic knee pain there’s a better option — a less invasive joint preservation procedure.

Most orthopedic practices around the country lack a joint preservation specialist, making it common for patients with knee and hip conditions to jump straight to joint replacement surgery. For the right patients, however, a joint preservation procedure may allow them to avoid joint replacement surgery altogether, said orthopedic surgeon James Ross, M.D., a sports medicine and joint preservation specialist with Baptist Health Orthopedic Care. Others can delay, often even for decades, the need for a more drastic surgery.

Orthopedic surgeon James Ross, M.D., sports medicine and joint preservation specialist with Baptist Health Orthopedic Care

Joint preservation procedures are most often used for people aged 60 and under who have early-stage osteoarthritis, suffer from bone impingement, have a ligament tear such as an ACL injury or have experienced a meniscus tear or other cartilage injury.

As an expert in joint preservation, Dr. Ross recently shared his experience with knee preservation with more than 115 physicians from 17 countries at the Baptist Health International World-Class Medical Care International Symposium. The meeting was also broadcast live to several medical schools in Latin America and the Caribbean.

“Surgery is constantly evolving and in the appropriately indicated patient has reliable outcomes for pain and function,” Dr. Ross said. “If we can prevent further knee damage by performing a minimally invasive procedure, we can prolong the lifespan of the knee joint.”

Nearly 800,000 knee replacements are performed in the U.S. each year. Because replacement joints typically last 15-20 years, there’s a good chance that younger patients will require another knee replacement later in life. That’s one of the reasons Dr. Ross considers joint preservation for younger, active patients.

Among the knee preservation procedures he performs are:

·      Osteotomy, where the tibia or femur is cut and repositioned to allow better alignment of the joint.

·      Osteochondral allograft transplantation surgery (OATS), where healthy donor tissue is used to replace defective areas of articular cartilage.

·      Matrix-induced autologous chondrocyte implantation (MACI), an FDA-approved procedure that uses a patient’s own cartilage cells to regrow new cartilage. MACI involves several stages, including the evaluation of the condition and removal (biopsy) of cartilage in the knee through arthroscopy. The cartilage is then sent to a lab in Boston so that new cartilage can be grown on a membrane or scaffold, and then the patient returns, typically in two months, to have the implant put into place via either an open or a minimally invasive procedure.

“After a MACI procedure, cells migrate from the membrane, through the fibrin glue, and begin to regenerate the patient’s own cartilage,” he said. Dr. Ross cited MACI’s success, determined in the randomized controlled European SUMMIT trial, which followed 144 patients who had either MACI or an older procedure called microfracture. The study showed that MACI significantly outperformed microfracture for the treatment of symptomatic cartilage defects of the knee.

“It is still very important to understand the environment, however,” Dr. Ross said. “Without correcting the underlying cause of the cartilage defects, such as malalignment, the patient will go on to have problems again in the future.”

In addition to surgical options for patients with a variety of knee conditions, physicians at Baptist Health Orthopedic Care also offer biologic injections, hyaluronic acid injections and other conservative treatments, including physical therapy, braces, splints and pain management.