A joint is the anatomical meeting point where two or more bones connect, allowing for movement and providing structural support. These structures are protected by cartilage, stabilized by ligaments, and powered by muscles attached via tendons. Surgical repair becomes necessary when this system is compromised by acute injury, chronic wear, or diseases like severe arthritis. When non-surgical treatments such as medication and physical therapy fail to provide relief, orthopedic surgery offers distinct approaches to restore function and eliminate pain. Techniques range from minimally invasive repairs to complete joint replacement, depending on the type and extent of the damage.
Joint Access and Visualization
The least invasive approach to accessing and viewing the joint interior is arthroscopy. This technique involves making a few small incisions, typically less than a centimeter long, to insert specialized instruments. The primary tool is the arthroscope, a thin, flexible tube containing a light source and a high-definition video camera.
The camera transmits an enlarged image of the joint’s internal structures, such as cartilage and ligaments, to a monitor for the surgeon to examine. This method significantly reduces trauma to surrounding muscles and soft tissues compared to traditional open surgery. Smaller incisions lead to less post-operative pain, minimal scarring, and a faster recovery time. Arthroscopy can be used purely for diagnosis or as the entire procedure for minor repairs, such as trimming damaged cartilage or removing loose bodies.
Joint Preservation Procedures
Joint preservation aims to repair or regenerate the body’s natural tissues to maintain the joint’s original structure rather than replacing it with artificial materials. This approach is often favored for younger, more active patients and involves repairing damaged soft tissues or restoring the protective cartilage. A common example is ligament reconstruction, such as repairing a torn anterior cruciate ligament (ACL) in the knee.
Ligament reconstruction typically involves replacing the torn ligament with a tissue graft, secured to the bone with fixation devices to restore joint stability. Meniscal repair is another frequent preservation procedure, where tears in the knee’s C-shaped cartilage cushions are stitched back together. Successful repair of the meniscus is important because its removal (meniscectomy) can accelerate the development of osteoarthritis.
Cartilage restoration techniques address damage to the smooth articular cartilage that covers the ends of bones. The microfracture procedure stimulates a healing response by making small holes in the underlying bone, which releases marrow elements that form a new, though less durable, fibrocartilage patch.
Another technique is Osteochondral Autograft Transfer (OATS), which involves transplanting small plugs of healthy bone and hyaline cartilage from a non-weight-bearing area of the joint to fill the defect. For larger defects, Autologous Chondrocyte Implantation (ACI) is a two-step procedure where healthy cartilage cells are harvested, grown in a laboratory, and then surgically implanted into the damaged area.
A surgical technique that shifts mechanical stress away from a damaged area is osteotomy, which involves cutting and realigning a bone near the joint. For example, a high tibial osteotomy can be performed on the shinbone to shift weight-bearing forces from the arthritic side of the knee to the healthier side. This procedure preserves the joint by reducing pressure on the damaged cartilage, often delaying the need for a total joint replacement. Osteotomy is frequently used with cartilage restoration procedures to allow the newly repaired tissue to heal without excessive loading.
Major Joint Reconstruction
When joint damage is too extensive for preservation techniques, major joint reconstruction becomes necessary. The most common procedure is arthroplasty, or joint replacement, which involves removing the damaged bone and cartilage surfaces and fitting the joint with an artificial implant, known as a prosthesis. The primary goals are to eliminate severe pain and fully restore joint function and mobility.
Arthroplasty can be categorized as either partial or total replacement, determined by the spread of the damage within the joint. A total joint replacement, such as a Total Knee Arthroplasty (TKA), replaces all damaged surfaces of the joint. For example, a total hip replacement replaces both the ball (femoral head) and the socket (acetabulum) with artificial components.
Partial joint replacement, or unicompartmental arthroplasty, is a more targeted procedure reserved for patients whose damage is confined to only one area of the joint. This approach preserves more native bone, ligaments, and healthy tissue, often resulting in a quicker recovery and a more natural feeling joint.
Prosthetic components are typically constructed from durable materials, including:
- Strong metals like titanium and cobalt-chrome.
- Highly polished ceramics.
- Specialized medical-grade plastics like polyethylene, which acts as the smooth, bearing surface.
Another reconstruction option is arthrodesis, or joint fusion, used when severe pain and instability cannot be managed by other means. In this procedure, the surgeon removes any remaining diseased cartilage, and the two bones forming the joint are intentionally fused together to create one solid bone structure. Fusion eliminates all motion in the joint but provides a permanent, stable, and pain-free solution, particularly for joints like the ankle, wrist, or small joints in the foot where motion is less critical. Arthrodesis remains a reliable option for end-stage arthritis, severe trauma, or when an infection prevents the use of an artificial implant.