JOINT PRESERVATION SURGERY

JOINT PRESERVATION SURGERY

Longevity, obesity and extreme sports  has caused an epidemic of knee pain.Time dependent correction of alignment, repair of meniscus. ligaments and cartilage  regeneration help knee the organ to delay or even avoid replacement . Active elderly lifestyle has pushed joint preservation techniques ahead. Below are a few of the techniques available at VPS lakeshore

Correct the mal-alignment by osteotomy

 Repair meniscus with enhanced techniques to promote healing using bone marrow derived mesenchymal stem cells or replacing meniscus  to  improve cartilage nutrition and shock absorption 

                                                                        

Meniscal replacement 

Repairing cartilage defects using gel based autologous cultured   cartilage cells 

Using below menrioned specific biological methods like

LR-PRP (leucocyte Rich r- PRP) in tendon injuries

LP PRP (leucocyte poor - platelet rich plasma) in early arthritis, 

SVF (Stromal vascular fraction)-microfat derived stem cells, 

Sanakine (interleukin 1 Alpha receptor antagonist) -  we   help joint  to repair itself Preserving the joint for better function in age and injury related deterioration of joint and tendons.

SVF - Harvested microfat before processing

Extensor apparatus rupture post knee replacement

patellar tendon  rupture post Knee replacement was  a disaster till about a decade ago. Percutaneous technique with strong figure of 8 nonabsorbabble mesh (neoligament here and hernia mesh earlier) Gave the knee a second life as guarded

  active exercises could be started day1 getting a  good function as below

Is synovial the omentum of knee

Synovial MSC,s have been touted as the storehouse of joints repair  tissue.  Are we missing  a local cheap scaffold  for Meniscal and cartilage repair. The pic above is an example of a synovial  scaffold in Meniscal repair.  Pt was good in 3 months although I do not have his post healing MRI or Scopy pics

Unusual appearance in place of ACL

Infected neoligament augmenting ACL reconstruction

Unsure of  intrarticular ‘ use of neoligament. Knowing the past disasters of ACL substitutes, I refrain from using any Intra-articulate  ligament substitutes including fibre tape augmentation. Intrarticular adhesion between the fat pad and acl and arthrofibrosis due to reaction to foreign body is the reason. This could be rare occurance although I have seen 2 in my Orthopedic   career.  I have no regrets using  Augments extraarticularly as I have seen less reaction ie; PLRI or patellar ligament

CULTURED OSTEOBLAST AND CORE DECOMPRESSION IN AVASCULAR NECROSIS HIP

This 40 year patient with AVN rt hip grade 2 and left hip grade 3 underwent hip replacement lt hip and core decompression and osteo blast injection rt hip. The xray and MRI showed remarkable improvement at 6 weeks. Did the osteoblast contribute to 6 week change? Although can't be definite, the amount of change on xray at 6 weeks was remarkable.

Preop                             6 weeks post op

  

one stage revisionTHR in infected Total hip repalcement- 11 year followup case

67 year old physically active gentlemen presented with an infected    THR 3 months post fracture neck .Hip aspiration grew sensitive  staph aureus.  A one stage revision was planned in the absence of Sinuses and Diabetes. To deliver local antibiotic loaded stimulan  beads were inserted into the femoral canal and a modular titanium finned straight stem was used to allow local delivery of antibiotic within the fins. Below in 11 year followup x-ray when he consulted us for spine related pain.

One stage revision is viable in  a non-immunocompromised host and a sensitive bug reducing inpatient morbidity