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Joint Preservation
 
Experiencing recurring or chronic joint pain doesn’t automatically mean that joint replacement surgery is your only option for relief.

Many people delay seeking treatment for joint pain for fear they will be told they need joint replacement surgery. However, there are non-surgical as well as surgical treatment options for joint preservation Causes of joint pain

You can damage a joint suddenly. Or joint damage may come on gradually, bothering you periodically at first and becoming more painful over time. The causes of joint pain may include:

• Tendonitis or tendon degeneration.
• Bursitis.
• Muscle strain.
• Meniscus or labrum cartilage.
• Arthritis.
• Injury from a fall or accident with bone or soft tissue trauma.
• Cartilage loss from trauma, or wear and tear.
• Osteonecrosis.
• Inherited abnormalities in the joint.

Most causes for joint pain never require surgery. However, even in the case of osteoarthritis, surgery is not necessarily the first choice. This is particularly true if you are a younger, active person.
What is joint preservation — and when is it the best option?

The goal of preservation is to prevent injury, reduce inflammation and preserve cartilage. The decision is taken by your physician after weighing your options based on the following parameters:

Age — Preservation techniques often are more successful the younger you are.
Weight — The more you weigh, the greater stress and demand is placed on your joint. Every pound you lose relieves three to five pounds of pressure on the hip, knee or ankle. Losing weight is the best thing you can do for an arthritic joint.

Muscle strength and conditioning — Muscles provide power to movement. They also serve as shock absorbers, protecting your joints. Maintaining or restoring muscle strength and flexibility reduces joint stress and pain.

Severity — Your doctor may sometimes manage small areas of cartilage thinning or erosion with minimally invasive procedures. However, if the cartilage is almost all gone — leaving bone touching bone, or if the bone underneath the cartilage is deteriorating, surgery is sometimes the best option although some injections can still help in those situations.
Location — Many joint preservation techniques focus on the knees. But there are an increasing number of alternatives to hip and shoulder replacement as well.

Non-surgical options for treating joint pain

1. Injections
Injections of hyaluronic acid, corticosteroids can reduce inflammation in many patients in the lining of the joints. These treatments can work in most joints and have been well-studied, however results are mixed. But not all insurance carriers will cover these injections.

2. Platelet-rich plasma and advanced biologic injections
Your blood contains platelets — hundreds of thousands of platelets are present in every millilitre of blood. These contain chemicals that can stimulate tissue repair, reduce inflammation and stimulate your own cells in the healing response.

Because of this, many clinicians have begun using injections of concentrated plasma which includes platelets from blood to treat inflamed or injured tendons, ligaments, muscle and joints.
There are also other more advanced biologics available — including stem cells — but these aren’t well studied (although they do show some promise). These substances include many of the same growth factors at higher concentrations and even some cells which may help achieving pain relief.

3. Cartilage transplant
In this technique, your treatment team will grow, transplant or use a cartilage replacement and place it in the damaged space. They can also stimulate the bone in your joint to increase cartilage growth. Not one technique is the proven best and much work needs to be done.

4. Partial replacement
Physicians use this technique when there is damage to smaller areas of your joint. The benefit to this technique is that the surgeon can preserve most of the bone with the use of smaller artificial parts to replace particular sections of your joint. This treatment works in many joints, but must be used carefully and does not work for all. Replacement in one part of the joint does not necessarily prevent degeneration in other parts of the joint. As a result, partial replacements may not last as long as a full joint replacement but the benefit is still being able to do a full replacement in the future.

Surgical joint preservation techniques include:

1. Osteotomy
Knee osteotomy is a surgical procedure that your doctor might recommend if you have arthritis damage in just one area of your knee. Osteotomy is also performed in combination with other types of knee surgery, such as cartilage surgery, if your leg is bowed or knock-kneed.
The procedure involves removing or adding a wedge of bone to your shinbone (tibia) or thighbone (femur) to help shift your body weight off the damaged portion of your knee joint.

2. Cartilage Restoration Procedures (including Allografts, Microfracture, and Biologic Grafts)
Cartilage Restoration is a procedure where a patient’s knee is resurfaced, realigned and stabilized thereby avoiding a joint replacement. Cartilage restoration is especially effective in patients who are under 50 and active. Articular cartilage is a firm, smooth and slippery covering on the ends of bones that protects and cushions the bone joint. Injuries to this cartilage can cause pain and swelling. If partially or fully detached injured cartilage can cause mechanical symptoms such as “locking up or “catching.”

Joint replacement surgery is generally performed for late stages of degenerative arthritis (also called osteoarthritis), after other options have failed. Most causes for joint pain including knee, hip, shoulder and ankle can be treated with far less invasive options
The benefits of full joint replacement
If you’ve unsuccessfully attempted conservative treatment or if damage to the cartilage or bone is beyond repair, remember that joint replacement is proven to be safe and highly effective in the right patient. Newer techniques in the hip and shoulder as well as knee can give patients excellent pain relief and improved function. However, there are always potential risks and complications with surgery.

Talk with your doctor about the best options and long-term strategies for you and understand what’s available for your specific problem. Preserving your joints and your activities and lifestyle should be the ultimate goal.

Dr. Muhammed Nazeer
Senior Consultant & Group Coordinator,
Orthopedics & Trauma, KIMSHEALTH
Trivandrum


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