Need a New Knee? Joint Preservation Surgery May Be Right for You

If your knee pain is making it difficult for you to golf, play basketball or chase after your kids — or the arthritis has progressed to the point where just walking down stairs and getting in and out of your car is unbearable — it may be time to consider surgery. But did you know that you might be a candidate for joint preservation surgery instead of having more-extensive surgery to replace the entire joint?

Joint preservation surgery has grown in popularity as technology has advanced, yet it still isn’t widely available because many health systems lack the specialists with expertise in the technique. Doctors at Baptist Health Orthopedic Care have extensive experience with this advanced procedure and are demonstrating how it can offer eligible patients more natural-feeling knee function and a speedier recovery.

Delay or Avoid Total Knee Replacement

And for some patients, there’s an even bigger benefit: They may never need a total knee replacement.

“If a patient is younger and active, and has preserved joint spaces, a cartilage restoration surgery may be ideal,” said James Ross, M.D., a sports medicine and joint preservation specialist with Baptist Health Orthopedic Care. “Joint preservation surgery allows some patients to delay total joint replacement surgery altogether or postpone it, often even for decades.”

Between 700,000 and 800,000 total knee replacements are performed in the U.S. each year, according to the American Academy of Orthopaedic Surgeons. Just over 30,000 patients receive joint preservation surgery.

Is Joint Preservation Surgery Right for You?

Cartilage restoration surgery isn’t for everyone, Dr. Ross said, but you might be a good candidate for the procedure if:

·      You have arthritis that is limited to one part of the knee

·      You have preserved joint spaces

·      Your cruciate ligaments are mostly intact and your knee is stable

·      You have adequate bone quality

·      You are younger and active

“It’s also important to look at any misalignment issues that may be contributing to knee damage and arthritis,” he said. “In order to have a good outcome, we must address those problems.”

Knee Preservation Options

There are a variety of knee preservation procedures available, and Dr. Ross chooses the best option for the patient’s individual needs. He may perform:

·      Osteotomy — cutting and repositioning the tibia or femur for better alignment of the joint

·      Osteochondral allograft transplant surgery (OATS) — taking donor tissue to replace defective areas of the articular cartilage, the connective tissue that covers the ends of the bones and acts as shock absorbers between the joints. Clinical Outcomes and Failure Rates of Osteochondral Allograft Transplantation in the Knee: A Systemic Review studied outcomes in more than 1,000 patients. The mean five-year survival of the allograft was 86.7 percent, 10-year survival was 78.8 percent and 5-year survival was 72.8 percent.

·      Microfracture — in which small holes are placed in the bone to encourage the body to regenerate the surface of the joint.

·      Matrix-induced autologous chondrocyte implantation (MACI) — using a patient’s own cartilage cells to regrow new cartilage. During arthroscopy, a cartilage biopsy is performed and cartilage is sent to an outside lab to grow on a membrane or patch. In a follow-up surgery, the implant is inserted, either in an open or minimally invasive procedure.“Within 48 hours, the cells migrate off of the membrane, adhere to the subchondral bone and start to propagate,” Dr. Ross said.

In the SUMMIT clinical trial, physician-researchers randomized patients into the microfracture or MACI groups to determine which procedure performed better. “What they found,” Dr. Ross said, “is that both groups improved, but the MACI group had significantly more improvement and maintained better KOOS (Knee Injury and Osteoarthritis Outcome Score) five years out.” KOOS helps patients rate their pain, function in sports and recreational activities, activities of daily living and knee-related quality of life.

“This is a very exciting time in the field because of the rapid evolution in joint preservation techniques,” Dr. Ross said. “But it’s also important to remember that physical therapy is essential for optimal recovery, whether you have a total knee replacement or joint preservation surgery. Most patients will see a significant improvement in knee function in three or four months, but full recovery can take up to a year or more.”

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