Jul 11, 2018

The future of orthopaedic and regenerative surgery

Bones and Joints Innovations in minimally invasive techniques mean patients are able to have a faster recovery period.

Arthritis is becoming increasingly common as people live longer, are becoming heavier and are indulging in more and more sports resulting in sports related damage to their joints and they also have a higher demand and greater expectation of outcomes from their doctors. Arthritis historically was a disease of the elderly but we are seeing younger and younger patients for the aforementioned reasons.

Arthritis is particularly disabling with severe pain, impaired mobility, stiffness and often mechanical symptoms of the joint locking or giving way.

Minimally invasive techniques

Minimally invasive surgery/arthroscopic surgery has made enormous leaps forward in recent years because of improved technology available to orthopaedic surgeons. The holy grail of orthopaedic surgery has always been to be able to repair or regenerate lost diseased or damaged cartilage in joints.

“The goal is to be able to perfectly regenerate cartilage and therefore repair a damaged joint.”

Increasingly this is becoming achievable in that more and more torn cartilages (menisci) in the knee are repairable, eg the Arthroscopy Association of North America estimates that up to 30% of meniscal tears should be repairable. This allows the surgeon, with minimally invasive surgery, to stitch or repair a torn cartilage in the knee rather than having to remove it. This allows for the patient to ultimately have a much more normally functioning knee with a significantly reduced risk of developing arthritis later on.

Orthopaedic surgeons are also using arthroscopic/minimally invasive techniques to stimulate the repair of joint surfaces, (articular cartilage) using a range of techniques including making tiny holes in the underlying bone to stimulate the repair process, using cartilage grafting techniques either from the patient themselves or from a donor. Additionally there are techniques available now whereby cells can be harvested from a patient, grown up in a lab and then later transplanted back into the patients damaged joint. It should be noted that all of these procedures are performed as day cases, are less painful and offer a faster recovery period.

Cellular based therapies

Other cellular based therapies are also growing in popularity using cells, either harvested from bone marrow or from fat and utilised to try and help stimulate a repair process in the damaged joint. Such techniques are becoming more and more widely available and practiced. Surgeons from the UK Biological Knee Society are working hard to develop and expand these techniques with the goal to be able to perfectly regenerate articular cartilage and therefore repair a damaged joint with the use of either simply needles or arthroscopic surgery.

The use of cell based therapies is obviously, and correctly, highly regulated in this country, Europe and North America but in some instances when looking at other countries one can get a glimpse into the future, eg the Kuala Lumpa Sports Medicine Clinic is already offering patients a service where their stem cells can be harvested, expanded and utilised for surgery within a relatively short period and then banked for future usage. This I believe will ultimately be available more close to home in the future.

The development of such cellular based therapies or ortho biologics, as they are termed, in my opinion, is the future of orthopaedic and regenerative surgery. The development of the cell based regenerative techniques will significantly reduce the need in the future for more major surgery such as joint replacement.

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