Alternatives to joint replacement: is arthrosis treated without surgery?

The pathology mainly affects elderly people. According to statistics, arthrosis is detected in 80% of people over 75 years of age . More often detected in men and women under 45 years of age. This state of affairs forces scientists to look for alternative methods of treating OA that can overcome it without traumatic surgery.

Healthy cartilage versus degenerative femoral head.

Osteoarthritis is characterized by damage to large joints, accompanied by destruction of intra-articular cartilage. Due to impaired blood supply and metabolism, cartilage tissue swells and loses elasticity, which leads to the development of destructive processes. Over time, cartilage wears out and becomes thinner. Subsequently, generative processes spread to the epiphyses of the bones involved in the formation of the joint.

This is what the cartilage of the knee joint looks like with osteoarthritis.

Currently, scientists from different countries are conducting research, the main goal of which is to learn how to restore the normal structure of articular cartilage. Unfortunately, they have not yet been able to develop a universal method to overcome OA without surgery.

Fact! Today, endoprosthesis replacement is the only radical method of treating deforming OA. All other methods can only slow down the development of the disease and improve the patient’s well-being.

Cell and tissue engineering

These areas of medicine study the problems of cartilage tissue regeneration. Articular cartilage is being restored using cell- and tissue-engineered structures (CEC and TEC). These two approaches have the same goal - to replace destroyed cartilage fragments with normal, complete tissue.

• KIC . The essence of the method is the intra-articular injection of a mixture containing a biostimulating matrix, multipotent mesenchymal stromal cells (MMSC) and bioactive molecules (growth factors, cytokines). The introduced substances stimulate the regeneration of cartilage tissue, thereby restoring the functions of the joint. Note that the biopolymer matrix is ​​responsible for delivering the components of the mixture to the cartilage, and the cells contained in the CIC have a regenerating effect.
• TEAK. Tissue-engineered structures are “grown” from CICs in special bioretractors that provide the necessary conditions for the proliferation and differentiation of cellular elements. Artificially synthesized cartilage tissue is implanted into the joint cavity, where it partially or completely replaces damaged cartilage.

Note that different types of biological material can be used for intra-articular injection or implantation. In particular, to stimulate the restoration of cartilage tissue, cell mixtures obtained from the human body or synthesized artificially are used. And for implantation, cartilage tissue that is own or “grown” in a bioretractor can be used.

Don't confuse engineering with transplantation. These are two completely different concepts. Remember that autotransplantation of your own tissues or fluids is not a method of cell or tissue engineering. These methods are discussed only in the case of the use of artificially synthesized or cultivated biomaterials.

Knee replacement in the Czech Republic: guarantees, prices, rehabilitation, reviews and statistics.

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Minimally invasive endoprosthetics in the Czech Republic: doctors, rehabilitation, terms and prices.

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Biomedical cell products for cartilage tissue regeneration

Nowadays, biomedical cell products containing autologous (that is, belonging to the person himself) chondrocytes are gradually being introduced into clinical practice. Some drugs are a pure substrate of these cells, others also contain a biodegradable carrier (matrix, scaffold).

Fact! Scientists believe that it is best to use cartilage cells from the nasal septum for cultivation. They have a fairly high potential for differentiation, and they are not difficult to obtain.

Table 1. Means for restoring cartilage tissue.

In addition to those listed in the table, there are many other cell engineering products (Chondrogen, MACI, ChondroCelect, etc.) that could theoretically be used to repair damaged cartilage. Unfortunately, they are all still in different phases of clinical trials. This means that they will begin to be used in practical medicine in at least a few years.

All about hip arthroplasty

Table of contents

• Indications and risks
• Before surgery
• Progress of the operation
• Complications after arthroplasty
• Postoperative period
• Advantages of carrying out the procedure at MEDSI

Hip arthroplasty is a type of surgery used to replace the hip joint (partial or total).
This manipulation comes in three types:

• In the first case, the cup of the joint is changed, it is used when one side of the joint is affected by disease or injury, and the endoprosthesis must be changed every 7 years
• In the second, the superficial part changes; it may require revision surgery 5 years after arthroplasty
• In the third, the entire joint is prosthetized; it is used for severe joint damage; such a prosthesis must be changed every 15–30 years

The endoprosthesis is usually made of high-strength titanium and cobalt alloys and consists of a head, a stem for installation in the femur area and a cup for placement in the notch of the iliac bone. Ceramic parts can also be used.

Indications and risks

Arthroplasty is used in cases such as:

• Severe form of open fracture of the hip joint (HT), femoral neck
• Degenerative diseases of TS
• Deforming arthrosis
• Congenital dysplasia TS
• Rheumatoid arthritis
• Hypotrophy of the pelvic, lower leg or thigh muscles
• Joint movement restrictions
• Aseptic necrosis accompanied by deformation of the femoral head
• Fibrous and bony ankylosis
• False joint
• Post-traumatic complications

But this operation is not prescribed (even if there are indications) in the following cases:

• The patient is obese
• Patients undergoing intensive treatment with a number of cortisone, insulin, etc. drugs
• The patient has been diagnosed with some chronic diseases (liver, cardiovascular and respiratory systems)
• The patient has an alcohol or drug addiction

Before surgery

Before prescribing the procedure, the specialist will direct the patient to undergo a series of examinations and tests:

• X-ray of the joint
• Blood tests

Since anesthesia will be used during the operation, the patient must inform the doctor in advance about any allergies to medications, if any. In accordance with these data, the optimal anesthesia regimen will be selected.

Progress of the operation

Hip arthroplasty is performed as follows:

• The patient is placed on the operating table and anesthesia is administered
• An incision is made over the joint area
• The muscle tissue is pulled apart or cut (in this case, they are subsequently sewn together)
• The destroyed parts of the joint are removed
• An endoprosthesis is being installed
• The joint is placed in the required position
• All cuts are stitched

The patient's condition is monitored by a physician for 5–10 days to monitor how successful the surgical intervention was.

Complications after arthroplasty

After the operation, the following complications are possible:

• Bleeding
• Blood clots
• Infectious inflammation
• Pneumonia
• Deterioration of the patient's condition

In the latter case, this means that the intervention was unsuccessful and a repeat operation is required.

Postoperative period

At the beginning of the rehabilitation period, it is recommended to take the following actions:

• Do breathing exercises
• Perform motor movements (turns) from one side to the other
• Use special devices for the bathroom and toilet
• Take painkillers (as prescribed by your doctor)
• Apply compresses to the operated area
• Gradually increase physical activity

The day after surgery, the patient can begin to walk on crutches. You can sit for 1–2 days. After 10–40 days (depending on the type of intervention performed and the type of prosthesis), it is possible to change the crutches to a cane. Recovery occurs 1.5–2 days after surgery.

Advantages of carrying out the procedure at MEDSI

• The MEDSI Center for Traumatology and Orthopedics performs arthroplasty in Moscow under optimal conditions
• Reception is conducted by specialists of high qualification categories
• The network’s clinics have a wide range of modern diagnostic equipment
• If necessary, hospitalization on the day of treatment is possible
• Reception takes place without long waits or queues

To make an appointment, call 24/7: 8 (495) 7-800-500

Creation of artificial cartilage

Not so long ago, scientists were confident that articular cartilage would be one of the first artificial tissues. However, in the process of its creation, the developers encountered a number of difficulties. As it turned out, copying the structure and biomechanical properties of cartilage tissue is extremely difficult, almost impossible.

To “grow” full-fledged cartilage that would be suitable for implantation, not only the presence of a matrix and growth factors is required, but also mechanical stimulation.

Nowadays, work is still ongoing on the creation of artificial cartilage that would exactly replicate the structure of natural ones. So far, this direction of engineering is considered the most promising. It is quite possible that the creation of high-quality TECs will soon become a real breakthrough in the treatment of deforming arthrosis.

Methods of cell and tissue engineering are still at the stages of development and implementation in clinical practice. They look quite promising, but so far they cannot completely replace endoprosthetics. However, there is a high probability that in just a few decades it will be possible to get rid of arthrosis with a few injections.

Surgery

If the effect of conservative measures is insufficient or the disease progresses rapidly, surgical treatment is required.
Coxarthrosis of the 3rd degree currently involves the complete replacement of a worn-out joint with an artificial one (hip arthroplasty). Other methods (osteotomy, arthrodesis) are outdated and are used in very rare cases, most often if for some reason it is not possible to perform endoprosthetics. Endoprosthetics (arthroplasty) is an operation performed in advanced stages of arthrosis, when one or both articular surfaces are destroyed. During the operation, the articulating articular surfaces are replaced with artificial (metal) ones. Between them there is a special liner designed to perform the functions of cartilage. The liner is made of various materials - polyethylene, ceramics or metal. , arthroplasty allows you to completely restore the lost functions of the joint.

Total joint replacement or total arthroplasty (endoprosthetics) today can be called the most effective method of ridding a person of the problem of arthrosis. Modern endoprostheses are made from special materials that are not only absolutely compatible with body tissues, but can also last a person’s entire life. Today, special endoprostheses have appeared in the arsenal of surgeons - with short legs and large anatomical heads. Such implants minimize damage to soft tissue during installation, and leave a large supply of intact bone tissue in case of possible future operations.

Endoprostheses are universal, but the size of each component is determined individually. In addition, when choosing an artificial joint, the age, physical condition of the patient, the presence of additional pathologies and features, professional and domestic activity, and many other factors are taken into account. Special designs are used in difficult cases - in patients with diplastic or post-traumatic coxarthrosis, in patients who have previously undergone other operations on the joint. The standard duration of a total arthroplasty operation performed by an experienced surgeon is about an hour. Blood loss is usually 200-400 milliliters. If the operation involves a large loss of blood, then in serious medical institutions they use the so-called. Cell-saver is a device that allows you to transfuse a patient with his own blood, which is collected during the operation; in this case, blood loss tends to zero.

Modern endoprosthetics is a fairly low-traumatic operation, in which the skin incision is usually within 7-8 centimeters, and deep tissues (muscles) are mainly separated or cut off, followed by anatomical restoration. It is the low-traumatic nature that determines the minimal pain syndrome after surgery.

Autotransplantation methods

Autologous transplantation is the use of the patient's own tissues and fluids to be introduced into the joint cavity. Nowadays, chondrocytes, progenitor cells from the periosteum and perichondrium, platelet-rich plasma (PRP), and multipotent mesenchymal stem cells (MMSC) are used for this purpose.

In the initial stages, the disease is not diagnosed, since there are no complaints, everything is asymptomatic.

Restoration of cartilage tissue is effective only in the initial stages of osteoarthritis, when bones are not yet involved in the pathological process. Unfortunately, engineering and autotransplantation techniques have not yet made it possible to eliminate bone tissue defects. A person with stage III-IV OA can only benefit from endoprosthetics.

How is the recovery course developed?

The primary rehabilitation program is usually developed by the doctor who monitors the patient in the postoperative period. After discharge it is corrected. Any classes or exercises should be carried out only according to the program prescribed by the doctor. Before this, the patient must be examined, X-rays and MRI results are studied.

There is no standard rehabilitation course for everyone. The program is always compiled strictly individually, for each patient.

In medical centers for rehabilitation, drug and non-drug recovery methods are used. To prevent complications after surgery, anti-inflammatory drugs, antibiotics, and painkillers are prescribed.

The main part of the rehabilitation course is exercise therapy and therapy. The rehabilitator conducts training that begins with simple exercises with a gradual increase in load. The patient moves from simple movements to exercise machines and other sports equipment.

Therapy includes many techniques, the most effective of which are physiotherapy, massage, acupuncture, and reflexology. All this is aimed at relieving muscle tension, accelerating recovery processes, relieving pain, normalizing sleep and preventing complications.

The hip joint is one of the largest supporting joints. When replacing it, the ligaments are removed, the muscles that will hold the endoprosthesis are cut and re-sutured. In order for muscles to cope with their function, they need to be trained and strengthened. Otherwise, the prosthesis may shift, which will lead to bad consequences.

Platelet Rich Plasma

It is known that platelets contain growth factors and substances that are potential chondroprotective agents. Therefore, PRP can be successfully used to stimulate regenerative processes in articular cartilage. Note that a good effect of treatment can only be achieved with plasma containing at least 1,000,000 platelets per 1 μl.

PRP is obtained by two-stage centrifugation of venous blood. The resulting material is administered in an amount of 5 ml three times with an interval of 2-3 days. Being absolutely safe, this technique allows you to improve the functional state of the joint and improve the patient’s quality of life. Note that the use of platelet-rich plasma is more effective in young patients with minor degenerative changes in the joints.

Stromal-vascular fraction of adipose tissue

Nowadays, MMSCs obtained from bone marrow and adipose tissue are used in regenerative medicine. Moreover, the use of the latter is more justified due to their easy production, high proliferative potential and low aging coefficient. Note that from an equivalent amount of adipose tissue, 1000 times more multipotent mesenchymal stem cells can be obtained.

The stromal vascular fraction (SVF) is the totality of all nuclear-containing cells (including MMSCs) that can be obtained from subcutaneous fat by enzymatic digestion. This substance has a pronounced regenerating, anti-inflammatory, antiseptic and immunomodulatory effect. According to many scientists, SVF of adipose tissue has many advantages compared to cell engineering methods and MMSC cultivation.

Fact! The preparation of SVF does not require cultivation, which can be complicated by microbial contamination, genetic transformation or spontaneous differentiation. This makes the stromal vascular fraction a more attractive product for use in clinical practice.