There’s a key player missing from most orthopedic practices around the country — a joint preservation specialist. Without this still relatively rare physician, it’s common for patients with knee or hip conditions to jump straight to joint replacement surgery when they might, in fact, experience a great outcome from a preservation technique.

For many, says orthopedic surgeon James Ross, M.D., a sports medicine and joint preservation specialist with Baptist Health Orthopedic Care, joint preservation procedures allow them to avoid joint replacement surgery altogether. For others, it can delay, often even for decades, the need for a more invasive surgery.

“Joint preservation surgery is constantly evolving and in the appropriately indicated patient has reliable outcomes for pain and function,” Dr. Ross recently told physicians at the Baptist Health International World-Class Medical Care International Symposium. The meeting was attended by 115 physicians from 17 countries and broadcast live to several medical schools in Latin America and the Caribbean.

Dr. Ross spoke to the group about knee preservation specifically. “If we can prevent further knee damage by performing a minimally invasive procedure, we can prolong the lifespan of the knee joint,” Dr. Ross says.

Dr. Ross particularly likes to explore joint preservation techniques for younger, active patients. Among the knee preservation procedures he performs are:

 

• Osteotomy, where the tibia or femur is cut and repositioned to allow better alignment of the joint.
• Osteochondral allograft transplantation surgery (OATS), where healthy donor tissue is used to replace defective areas of articular cartilage.
• Matrix-induced autologous chondrocyte implantation (MACI), an FDA-approved procedure that uses a patient’s own cartilage cells to regrow new cartilage. MACI involves two stages. First, through arthroscopy, the surgeon determines the size of the defect or defects and makes sure it is isolated and not a diffuse cartilage disorder. During this procedure, a cartilage biopsy is performed, and cartilage is sent to a lab in Boston so that the chondrocytes, or cartilage cells, can be multiplied on a membrane or scaffold. During the second-stage surgery, the patient returns, typically in two months, to have the implant put into place via either an open or a minimally invasive procedure.

“After a MACI procedure, cells migrate from the membrane, through the fibrin glue, and begin to regenerate the patient’s own cartilage,” he said. Dr. Ross cited the randomized controlled European SUMMIT trial, which followed 144 patients for two years following MACI or microfracture. The study showed that MACI significantly outperformed microfracture for the treatment of symptomatic cartilage defects of the knee.

“It is still very important to understand the environment, however,” Dr. Ross said. “Without correcting the underlying cause of the cartilage defects, such as malalignment, the patient will go on to have problems again in the future.”

In addition to surgical options for patients with a variety of knee conditions, physicians at Baptist Health Orthopedic Care also offer biologic injections, hyaluronic acid injections and other conservative treatments, including physical therapy, braces, splints and pain management.