Joint preservation: Everything you need to know

Joint preservation is an innovative approach to managing joint issues that focuses on preserving the natural joint function.

Mr Asif Parkar, leading consultant orthopaedic surgeon (knee and hip specialist), provides an expert insight into joint preservation, explaining its purpose, techniques, and success rates.

What is joint preservation?

Joint preservation encompasses a range of medical and surgical procedures designed to protect, repair, or restore joint function. Unlike joint replacement, which involves replacing damaged joints with artificial implants, joint preservation maintains or improves existing tissues, aiming to preserve the natural anatomy of the joint for as long as possible.

This approach is particularly beneficial for younger patients or those with early-stage joint damage who wish to maintain a high level of physical activity. For instance, conditions commonly treated with joint preservation include early osteoarthritis, cartilage injuries, ligament tears and hip dysplasia.

What are the most effective joint preservation techniques/procedures currently available?

Joint preservation procedures vary depending on your condition, the severity of joint damage and the specific joint involved. Some of the most effective techniques include:

Arthroscopy

Arthroscopy is a minimally invasive surgical technique that is effective in treating joint injuries such as meniscal tears, cartilage damage and ligament injuries. During the procedure, small incisions are made to allow for the insertion of a camera and specialised surgical instruments, enabling your orthopaedic surgeon to repair or remove damaged tissues.

Cartilage restoration

For patients with severe cartilage damage, cartilage restoration techniques such as microfracture surgery, autologous chondrocyte implantation (ACI), and osteochondral allograft transplantation are commonly employed. These methods help regenerate cartilage or replace damaged areas with healthy cartilage tissue.

Osteotomy

Osteotomy is often used for patients with early-stage arthritis or malalignment in the knee or hip. During the procedure, your orthopaedic surgeon cuts and realigns the bones around the joint, redistributing weight and reducing pressure on damaged areas. This way, osteotomy can significantly delay the need for joint replacement surgery by protecting the remaining healthy cartilage.

How does cartilage restoration work?

Cartilage is an essential component of joints, acting as a smooth, protective layer that absorbs shock and allows smooth movement of bones. However, cartilage also has limited self-repair capacity. When cartilage becomes damaged due to injury or wear, cartilage restoration techniques can regenerate or replace the damaged cartilage to prevent further joint degeneration.

One common method is microfracture surgery, where small holes are created in the underlying bone to stimulate the growth of new cartilage tissue. While the resulting cartilage isn’t identical to the original, it can still improve joint function and reduce pain.

Another advanced technique is ACI, which involves harvesting healthy cartilage cells from the patient, growing them in laboratory, and implanting them back into the damaged area.

For more extensive damage, osteochondral allograft transplantation may be recommended. This involves transplanting healthy cartilage and bone from another part of the patient’s body (autograft) or a donor (allograft) to the damaged area, providing a natural repair option for larger cartilage lesions.

What is the success rate of joint preservation?

Joint preservation procedures are highly effective for many patients, offering relief from pain, improved mobility and a delay in the progression of joint degeneration. For example, studies have shown that microfracture surgery has a success rate of approximately 60-80% for small cartilage defects.

More advanced cartilage restoration techniques, such as ACI, lead to up to 85% of patients experiencing significant improvement in joint function and pain relief. Osteotomy procedures also demonstrate high success rates, particularly in younger patients, as they effectively delay the need for joint replacement surgery by 10 to 15 years.

After a full recovery, most patients can also resume sports or other physical activities. Arthroscopy usually require 4-6 weeks of recovery, while more complex surgeries like osteotomy or cartilage restoration may take 6-12 months. A structured rehabilitation programme, guided by a physiotherapist, plays a crucial role in achieving optimal outcomes.

However, it’s important to understand that joint preservation doesn’t completely eliminate the risk of future joint degeneration. Success rates can also vary depending on individual factors. Early intervention can make a significant difference, improving your quality of life and delaying the need for more invasive procedures.

To book an appointment with Mr Parkar, head on over to his Top Doctors profile today.