Dr.A.K.Venkatachalam FRCS, M.Ch Orth, DNB Orth, MS Orth is an UK board certified orthopaedic surgeon.
He offers joint preservation surgery. He has acquired training for these procedures in the UK, USA and Singapore.
He has visited reputed center in the UK & Belgium to observe and assist in these procedures.
About Joint preservation
What is Joint preservation?
It is an emerging field in orthopaedic surgery whose goal is to prevent or delay the onset of osteo-arthritis in a joint, particularly in young patients. Young patients are very active and have a high demand.
The procedures include osteotomies, arthroscopy, ligament reconstruction and also conservative treatment. If you already have cartilage damage that cannot be reversed completely, I can try to lessen symptoms and delay the degenerative process.
Both the upper and lower limbs come under its purview. Some of the procedures that are performed include the following.
- Ligament reconstruction- Soft tissue has a role in joint preservation. Not all ligaments need to be addressed. In the knee, ACL repair or reconstruction is a form of joint preservation because it protects the meniscus. I have added stem cell augmentation of ACL repair to improve the results. I am also keen on ACL repair in fresh cases to preserve the original anatomy of the native ACL. ACL reconstruction is done only for chronic ACL deficiency with a wide separation between the ends. I use PRP and stem cell injections to augment ACL reconstruction.
- Meniscal repair & replacement– Meniscal tears can occur in isolation or along with other injuries. Menisci are the shock absorbers of the knee. Preserving the menisci is crucial to delay osteo-arthritis. Fresh meniscal tears in the vascular zone can be repaired surgically and will heal. In those cases where the meniscus has already been removed, a meniscal replacement is now available.
- Osteotomies- In my practice this is mainly applicable to the knee. Young patients with uni-compartmental arthritis and mal alignment can be treated with osteotomies to unload the affected part and transfer load to the unaffected part. This works through biological methods. It can postpone or delay a knee replacement by several years. High tibial osteotomy ( HTO) and lower femoral osteotomy (LFO) are the commonly performed procedures.
- Preservation of Joint cartilage- In the past two decades, cartilage repair procedures have made vast progress. Autologous chondrocyte implantation (ACI) is one of the procedures. I was the first to use a fourth generation autolgous chondrocyte implantation (ACI) in Chennai. See a patient testimonial here. Currently I use MSC’s to repair cartilage defects in young patients. See a patient testimonial here.
- Knee distraction– This is an option for those patients who already have osteo-arthritis but want to avoid a knee replacement. It involves use of an external fixator for six weeks followed by mobilization.
- Conservative treatments– I explore other possibilities before suggesting a surgical procedure. These include use of a brace, footwear modifications etc. Conservative treatment means prevention. It means early rehabilitation. It may also involve early surgery to prevent further damage. It means adequate comprehension of clinical ‘bio mechanics’ or ‘joint dynamics’
- Hip procedures- The hip joint deserves special mention in India. Avascular necrosis (AVN) is the commonest hip condition in India. It affects the young population. It is caused by death of bone. Early cases of AVN can be treated with core decompression and stem cells. Other joints with AVN can be also treated with the same principles. Early cartilage damage can be treated with biological methods using stem cells.
- Other joints– The shoulder and ankle are other joints where joint preservation can be tried. Arthroscopy is a major tool to address some of these conditions. Rotator cuff repairs can be augmented with stem cells or PRP. Labral tears can be treated with stem cells. Ankle instability can be treated with targeted stem cells. If arthritis has already developed in the ankle, distraction arthroplasty has shown promising results in the literature as opposed to ankle fusion. I have used marrow stimulation in the shoulder to cure symptoms.
Evaluation of results– I use a number of methods to evaluate whether a joint preservation procedure is effective. These are subjective and objective outcome measures, MRI and x rays. Patient reported outcome measures ( PROM’s) are very much relevant to the outcome of the treatment.
What does it take to achieve success in joint preservation-
Many surgeons offer joint preservation in India.
It needs versatility with surgical exposures of joints. Understanding the clinical bio mechanics or joint dynamics is vital to success. Training in these procedures is necessary. I have undergone cadaver courses in the US and Singapore. I will be attending further courses in the US this summer.