Biologic Joint Preservation
Biologic joint preservation involves a group of treatment options that repair damage to a specific joint for patients who do not yet need or wish to delay joint replacement surgery. Joint preservation procedures are most often performed on patients with sports injuries, mild to moderate arthritis, and other chronic injuries or joint related conditions.
There are many treatment options available to help preserve the function of the joint while avoiding the need for joint replacement surgery. These treatments are often performed on younger patients and use arthroscopic techniques to minimize trauma to the joint through a minimally invasive, arthroscopic procedure. After recovering from these procedures, patients can continue to enjoy an active lifestyle with significant joint relief and improved joint function.
The most effective joint preservation procedure may vary depending on each patient's individual condition. Which procedure is best for you, after a thorough evaluation of your condition, which may include a physical examination, X-rays and other imaging tests will be determined by your physician.
Some of the joint preservation procedures performed include:
Osteochondral Autograft and Allograft Transplant Surgery (OATS)
The Osteochondral Autograft or Allograft Transplant Surgery, commonly known as OATS, replaces damaged cartilage in the knee with healthy cartilage from another area of the joint or from a donor, relieving pain and restoring movement and function to the joint. A mosaicplasty is the name for a general procedure that treats severe cartilage damage, and the OATS procedure is a type of mosaicplasty.
While cartilage is essential for ensuring smooth, painless movement of the joints, some areas have a more critical need for the support and cushioning provided by the cartilage. During the OATS procedure, small plugs of healthy cartilage are transferred to the damaged area from areas that are not in critical need or from a donor.
The OATS procedure is ideal for patients with small areas of cartilage damage that can be easily repaired with a graft. Widespread cartilage damage cannot usually be treated with this procedure, since there may be insufficient amounts of healthy cartilage available.
After the OATS procedure, patients will need to undergo a lengthy physical therapy program in order to restore range of motion and relieve pain and swelling on the joint. Long-term follow-up care will be required in order to maintain the results of this procedure.
Autogenous Cartilage Implant Surgery (ACI)
Autologous Chondrocyte Implantation, commonly known as ACI, is a surgical procedure that treats cartilage damage caused by injury or degeneration. This procedure is most often performed to treat the knee, although it can be used on other joints as well. It is used after nonsurgical treatments have failed and cartilage damage is severe.
During the ACI procedure, your surgeon will use arthroscopy to identify the area of cartilage damage and remove a small sample of healthy cartilage cells. These cells are sent to a lab, where they are duplicated over the next two to six weeks. Once enough cells have been grown, a second procedure is scheduled, during which the new cartilage is implanted into the joint with the aid of a periosteal patch.
After this procedure, patients will need to undergo a physical therapy program in order to restore full function to the treated area. The ACI procedure is ideal for patients with only small areas of cartilage damage, who have significant pain and swelling, and who are not obese. This procedure is considered safe for most patients, although there is a risk of scar tissue formation, infection and knee stiffness developing after surgery.
Osteotomy is an arthroscopic procedure used to treat osteoarthritis and other forms of arthritis after conservative treatments have failed. This procedure involves removing a wedge of the bone that is located near the affected joint in order to shift the weight from the damaged area to an area with healthier cartilage. Once the bone has been removed, the remained ends are pinned or stapled together and immobilized with a cast or internal plate to ensure proper healing.
The osteotomy procedure is ideal for patients with uneven joint damage and a correctable deformity. Most patients are under the age of 60 and maintain an active lifestyle. It is often effective in relieving pain and slowing the progression of osteoarthritis, although it is likely that patients will eventually need joint replacement after undergoing this procedure. Patients will need to undergo physical therapy and rehabilitation after the osteotomy procedure and can usually return to all regular activities after three to six months.
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