Joint Preservation

Dr. Lonnie Paulos is one of the leading orthopedic surgeons in this country. With over 30 years of experience, he understands the need for joint preservation before the need for total knee replacement.

Joint preservation is an emerging field in orthopedics that has evolved primarily in response to the need for treatments for cartilage damage and early arthritis before the need for total joint replacement. Dr. Paulos has researched and developed many of the treatments of joint preservation as a way to prevent or delay the onset of osteoarthritis or other degenerative conditions affecting the joints, particularly in young patients. His goal is choosing the best procedure with evidence-based analysis.

There is a wide spectrum of chondral (cartilage) disease of the knee. Not all early knee problems are just “early arthritis” – these chondral diseases have numerous etiologies such as focal traumatic chondral injury, meniscal disease and root tears, ligament instability, malalignment, AVN (avascular necrosis), inflammatory conditions, and systemic diseases. The surgical management of chondral disease is dependent on many factors including accurate diagnosis, location of disease, grade and extent of disease, nature of concomitant (accompanying) injuries, and the soft tissue envelope around the knee.

Goals of joint preservation surgery are to delay and minimize degeneration, decrease pain, increase function, and avoid further articular cartilage or soft tissue damage. There are numerous alternatives to arthroplasty, and these can be performed all arthroscopic, all open, or a conjunction of the two techniques. Operative management of chondral injury includes procedures for small lesions which include microfracture, OATS (osetochondral autograft tranplantion), and synthetic plugs. For larger lesions, allografts or ACI (autlogous chondrocyte implantation) are more commonly used. A critical decision is whether a concomitant (accompanying) osteotomy is necessary or if just an osteotomy is sufficient without an intra-articular procedure.

Joint preservation can be a very efficient procedure to prevent or at least delay OA (osteoarthritis). Young patients with degenerative joints now have an option of doing some joint preserving procedures that have the possibility of delaying total knee replacement for years to come. Dr. Paulos has innovative techniques and is one of the few surgeons on the cutting edge of these procedures.

Addressing the soft tissue also has a place in joint preservation. Dr. Paulos suggests that ligament reconstruction in sports medicine and for traditional joint pathology is essential to combat joint degeneration.

The "less is more concept" in joint preservation also encompasses steroidal and HA (hyaluronic acid) injections as a consideration in joint preservation. HA injections are useful in halting progression of degenerative joint disease, but patients react to them differently, so it is not an effective means of managing symptoms in the long-term.

There are a variety of methods to determine how well an intervention has helped preserve a joint. In addition to MRI and radiographs, Dr. Paulos regularly assesses his joint preservation efforts with objective and subjective outcome measuring with all of his patients.

In the past 20 years, imaging and the field of cartilage repair have improved considerably, which has also shown significant functional improvement and pain reduction. Knee cartilage repair techniques that involve an implantation process have been developed for very specific, isolated cartilage repair helping with functionality and pain.

If you would like to discuss your knee pain with Dr. Paulos, please call our office today so we can make an appointment for an examination.