JOINT PRESERVATION

Joint Preservation in orthopaedics refers to strategies, treatments, and surgical techniques that aim to delay or prevent joint replacement (such as total knee or hip arthroplasty) by maintaining the native joint structure and function for as long as possible.

🔹 Goals of Joint Preservation

Reduce pain

Improve or maintain joint function

Delay or avoid the need for joint replacement

Preserve native bone and cartilage

🔹 Who Needs Joint Preservation?

Younger patients with joint damage (e.g. early osteoarthritis)

Athletes or active individuals with cartilage or ligament injuries

Patients with post-traumatic joint changes

Early or focal cartilage damage (not end-stage arthritis)

🔹 Non-Surgical Joint Preservation Techniques

Weight Management

Reduces load on joints (especially knees and hips)

Physical Therapy

Improves joint mechanics and muscle balance

Activity Modification

Avoid high-impact activities that accelerate cartilage wear

Orthotics & Bracing

Offload affected compartments (e.g., unloader knee brace)

Injection Therapies

Corticosteroids, PRP, hyaluronic acid, stem cells (as discussed earlier)

Medications

NSAIDs, glucosamine/chondroitin (limited evidence)

🔹 Surgical Joint Preservation Techniques

1. Arthroscopy

Minimally invasive; for debridement, synovectomy, or cartilage repair

Often used in knees and shoulders

2. Cartilage Restoration Procedures

Microfracture: Stimulates new cartilage growth from marrow

Osteochondral Autograft Transfer (OATS): Transplanting cartilage plugs from non-weightbearing areas

Autologous Chondrocyte Implantation (ACI): Cultured cartilage cells re-implanted into defect

Osteochondral Allografts: Cadaveric cartilage grafts for large defects

3. Osteotomy

Realigns bone to shift load away from damaged joint area

Common in knee osteoarthritis (high tibial osteotomy for varus knees)

4. Meniscus Preservation (in knees)

Meniscal repair instead of removal

Meniscal transplantation (for younger patients with prior meniscectomy)

5. Ligament Reconstruction

ACL or PCL reconstructions to restore stability and prevent cartilage damage

🔹 Emerging/Advanced Therapies

Biologic therapies: PRP, stem cells, growth factors

3D-printed scaffolds: For custom cartilage repair

Gene therapy: Experimental, to promote cartilage regeneration

🔹 Joint Preservation vs Replacement

Aspect Joint Preservation Joint Replacement

Age group Younger, active Older, low-demand

Goal Delay degeneration Replace damaged joint

Recovery Shorter (usually) Longer recovery

Durability Variable High, but prosthesis has lifespan