As knee pain progresses from interfering with athletic activities to limiting activities of daily living such as navigating stairs or getting in and out of the car, surgical intervention may become necessary. While total knee arthroplasty remains the gold standard for end-stage arthritis, cartilage restoration surgery presents a viable alternative for appropriately selected patients, offering the potential for more natural joint mechanics and a speedier recovery.

Joint preservation surgery has gained traction as technology has advanced, though accessibility remains limited due to a lack of surgeons with adequate training. Fortunately for your patients in South Florida, or for those who can travel to the area, doctors at Baptist Health Orthopedic Care have extensive experience in these techniques and are demonstrating improved patient outcomes.

Long-term Joint Preservation Benefits

For carefully selected patients, joint preservation surgery may provide substantial long-term benefits, potentially eliminating or significantly delaying the need for total knee arthroplasty.

Statistics from the American Academy of Orthopaedic Surgeons indicate that while 700,000-800,000 total knee replacements are performed each year in the U.S., only some 30,000 patients receive joint preservation surgery. This suggests significant underutilization of the procedure.

“If a patient is younger and active, and has preserved joint spaces, a cartilage restoration surgery may be ideal,” said James Ross, M.D., a sports medicine and joint preservation specialist with Baptist Health Orthopedic Care. “Joint preservation surgery allows some patients to delay joint replacement surgery altogether or postpone it, often even for decades.”

At a Baptist Health Orthopedic Care Symposium, Dr. Ross reviewed patient selection criteria and discussed patient cases and the latest advances.

Patient Selection Criteria

Successful outcomes with joint preservation surgery require stringent patient selection. Ideal candidates present with:

• Unicompartmental arthritis with disease limited to a single knee compartment
• Preserved joint spaces
• Intact or minimally compromised cruciate ligaments
• Knee stability
• Adequate bone quality
• Younger age with moderately active lifestyle demands

Critical to successful outcomes are the assessment and correction of any malalignment contributing to progressive joint degeneration. Failure to address underlying biomechanical abnormalities significantly compromises long-term results, Dr. Ross said.

Surgical Options and Techniques

Multiple joint preservation procedures are available, with technique selection based on individual patient pathology. Among the procedures Dr. Ross performs are:

Osteotomy, which involves precision cutting and repositioning of the tibia or femur to restore optimal joint alignment and load distribution.

Osteochondral allograft transplantation surgery (OATS), which utilizes donor tissue to replace defective areas of the articular cartilage. A systematic review examining outcomes in more than 1,000 patients demonstrated mean allograft survival rates of 86.7% at five years, 78.8% at 10 years and 72.8% at 15 years, indicating durable clinical results.

Microfracture to create controlled subchondral perforations to stimulate joint surface regeneration.

Matrix-induced autologous chondrocyte implantation (MACI), an advanced two-stage procedure utilizing the patient's own chondrocytes. During initial arthroscopy, cartilage biopsy is performed with cells sent to specialized laboratories for growth on biocompatible membranes. Subsequent implantation, performed through open or minimally invasive approaches, allows cellular migration and adherence to subchondral bone within 48 hours, initiating cartilage regeneration. “Within 48 hours, the cells migrate off of the membrane, adhere to the subchondral bone and start to propagate,” Dr. Ross said.

Evidence-based Outcomes

The SUMMIT clinical trial compared microfracture and MACI procedures through randomized patient allocation. Results demonstrated significant superiority of MACI over microfracture, with the MACI cohort showing greater functional improvement and sustained superior Knee Injury and Osteoarthritis Outcome Score (KOOS) results at five-year follow-up. KOOS assessment encompasses pain levels, sports and recreational function, symptom severity, activities of daily living, and overall knee-related quality of life.

Recovery and Rehabilitation

While most patients see good improvement in knee function in three to four months, full recovery can take up to a year or more, said Dr. Ross. "This is a very exciting time in the field because of the rapid evolution in joint preservation techniques, but it's also important to remember that physical therapy is essential for optimal recovery, whether you have a total knee replacement or joint preservation surgery,” he said.

For a referral to a Baptist Health Orthopedic Care doctor, call 786-268-6200.