Joint Resurfacing Overview
Historically, damaged joints (primarily knees) in active adults have been treated by one of two methods: either arthroscopic “clean up”surgery, or total joint replacement. However, many people do not get sufficient relief from a “scope clean up” and are not appropriate candidates for a “total joint.” Total joint replacement provides excellent relief from painful arthritis, but surgery is extensive, and has its limitations. For example, total joints have a limited life-span (10-20 years), and high-impact sports are not recommended on a traditional total joint. Regular athletic use can shorten the expected longevity of a traditional total joint, so this may not be an ideal solution for younger, active or athletic people. In addition, a total knee replacement involves sacrificing internal ligaments, as well as quite a bit of bone: cutting off the end of the femur, back of the patella and top of the tibia. This is a highly invasive procedure that limits any future options should the prosthesis wear out or come loose.
Alternatively, the field of Joint Resurfacing is a new approach that offers very attractive and exciting alternatives for active adults with joint damage and pain. This approach focuses exclusively on resurfacing or replacing only the damaged parts of the joint, while preserving and retaining all the healthy bone and tissue. It leaves the joint feeling and working more normally. The patient retains an improved sense of balance and position, allowing a return to all sorts of athletics, and activities which would otherwise be painful or impossible.
There are different forms of joint resurfacing, and these may be combined with each other as well as some cartilage restoration techniques. The least invasive method is an “inlay.” Inlay resurfacing is very much like replacing damaged tiles on a tile floor. Rather than ripping out the whole floor to repair a broken or damaged tile (the cartilage), the local area can be resurfaced with an implant specifically contoured to that region of the joint. Inlay implants come in a variety of shapes and sizes.
While these implants are very useful, they are limited in terms of what kind of deformities they can repair. Once the joint becomes crooked or deformed, we typically resort to using an “onlay”resurfacing implant. Onlay implants cover the ends of the damaged joint, allowing a normal angle and position to be reestablished while providing a new, smooth surface. Like inlay implants, onlays come in a variety of shapes and sizes. The patellofemoral (knee cap joint) can particularly benefit from joint resurfacing. Many patients have been told that they have limited or no options. By combining special techniques to align the joint, it can be resurfaced and relieve pain, allowing for nearly normal activities and relief of pain in the front of the knee.
There are some patients, especially younger people with advanced deformities, that benefit from complex joint resurfacing. Dr. Davidson has special expertise in applying a combination of complex techniques to offer relief to patients looking for an alternative to Total Joint replacement surgery.
Even with these modern methods, however, when all three parts of the knee are deformed and the knee is limited in motion, a modern total knee replacement may be necessary and can be an excellent alternative. Unlike traditional procedures, a modern total knee replacement now utilizes digital information technology to precisely pre-plan the procedure. Using this technology, the entire limb is digitized and a preoperative plan is developed to create guides for precise cutting and sizing. In addition, modern materials used for today’s total joint replacements allow many athletes to return to activities such as skiing, hiking, biking, tennis, equestrian, and other limited impact sports.