Future of Joint ReplacementsDr. A K VenkatchalamMJRC Clinic, Chennai

Needle may replace scalpel • Regenerative medicine is an exciting field in Orthopedics.• Possible to treat Osteoarthritis of knee and hip with stem cells

injected through needle. • This is possible by better understanding of the pathology of

osteoarthritis.

We have the technology, we can rebuild him…

• PRP (Platelet-Rich Plasma)• Stem cell treatment• Tissue engineering

Rebuild

Regenerate

Joint preservation in knee

• Increasing role for osteotomies, meniscal replacement, meniscal transplant, Osteochondral grafts, articular cartilage repair.

• The joint is not replaced but the abnormal biomechanics in and around the joint are altered

• These may postpone the date for a knee replacement. • Biological knee replacement possible with cadaveric menisci,

synthetic menisci, cadaveric ligaments, osteo-chondral grafts.

PRP (Platelet-Rich Plasma)

Cell therapies have even gone beyond surgery to office-based injections only.• Stem cells and growth factors, such

as PRP (Platelet-Rich Plasma) are directly injected into the knee

• The cell therapies are now also being used experimentally in conjunction with regenerative surgeries to enhance, and possibly accelerate the healing process

Advances in Joint Replacement

• Newer materials which increase longevity of the implant.• Cement-less fixation of knee implants.• Smart tools like the I-Assist provide intra operative navigation.• Validated soft tissue balancing tools – E-Libra• Kinematically aligned knee replacement vs Mechanically

aligned knee replacement. • Biological knee replacements – Can be done in incremental

steps in India with tissue bank assistance.• Customized implants – These are available abroad.

Materials

• Femoral components made of Oxidized zirconium

• Plastic tray made of highly cross linked polyethylene.

• Vitamin E incorporated durable poly inserts

Image-guided and Robotic Surgery

• Image-guided surgery (sometimes called computer-assisted surgery) is a technique where surgery is performed with the aid of computerized images.

• Latest disposable navigation devices are I Assist and Ortho align

• Navigation may be useful in young patients• Only about 1 in 100 knee operations are currently

performed in this way. Results so far suggest this technique offers greater accuracy in positioning the new knee joint.

• However, there is no evidence that it leads to better function or survival of a knee replacement.

Smart tools

• I-Assist smart tool • Ortho align smart tool.

• Soft tissue balancing tools

Cementless Knee Replacements

• Cemented knee replacements have been the most popular so far, but cement-less knee replacements are available

• Components with a coating which has tiny holes in or which is made from crystal can be used. This allows the bone to grow on to and bond directly to the component. It’s thought that this could provide a longer-lasting bond than cement, which may break down over time.

• However, there’s currently no evidence that the components themselves are better in terms of pain relief, function, or how long they last.

• Research continues into the pros and cons of cementless versus cemented knee replacements.

LET’S WELCOME THE FUTURE