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It is estimated that in the next 25 years at least 71 million Americans will have some form of arthritis, a degenerative condition of the joints, creating pain, swelling and limited movement for sufferers. Osteoarthritis is notably one of the most debilitating forms of arthritis and is characterized by the deterioration of articular cartilage accompanied by changes in the subchondral (below the cartilage) bone and soft tissue of the joint.
While joint replacement surgery has shown promising results for thousands of patients, it isn’t always the answer for the treatment of advanced osteoarthritis. In recent years, joint preservation and joint restoration techniques have allowed individuals to put off joint replacement surgery. In general, these are performed in patients who may have some localized areas of pathology, bone spurs that are decreasing their motion, or any other patients for whom a total joint arthroplasty may not be indicated because of their age, activity level, or weight.
The most common form of joint preservation surgery is arthroscopic. In this circumstance, a clean out of all the pain mediators in the knee may be indicated. This would involve removing irritated synovium, releasing scar tissue and contractures, removing offending bone spurs, and trying to improve a patient’s motion in both their patellofemoral joint and the tibiofemoral joint. This would especially involve patellar mobilization and trying to regain full knee extension.
Other forms of joint preservation surgery can be more specific. These include treatment of localized areas of arthritis with a microfracture, an autogenous osteochondral transfer, or a fresh allograft. These can be performed with or without a proximal tibial or distal femoral osteotomy, or a meniscus transplant. All of these are considered to be “joint preservation surgeries,” but are usually indicated in patients who have a thorough clinical exam, radiographic workup, and MRI scans which demonstrate their suitability for these procedures.
Arthroscopic joint preservation surgery has been found to be very effective at The Steadman Clinic when it is combined with an aggressive post-operative rehabilitation program with focus on daily physical therapy for 1-2 weeks after surgery to make sure the patient has maintenance of their range of motion, has reactivation of their muscles and has attempts to decrease swelling post-operatively. It is especially important to try to control knee swelling because this will cause quadriceps shutdown and atrophy, increased pain, and can limit motion.
In general, the results of joint preservation surgery are very dependent upon the patient working with a physical therapist following surgery. A properly guided rehabilitation program is essential to achieve one’s maximal outcomes after this type of surgery. In fact, if a patient cannot participate in this type of therapy program, we will generally discourage an arthroscopic joint preservation surgery because we have found that in patients who do not participate in physical therapy commonly have a recurrence of stiffness, scarring, and muscle atrophy.