Today’s broad arthroplasty landscape offers a variety of options to patients seeking treatment for osteoarthritis, traumatic events or avascular necrosis. Depending on the degree of cartilage injury, their age, and their desired activity level, patients may be candidates for microfracture (marrow stimulation), grafting, injections, joint preservation surgery, or a traditional total joint replacement. Of the surgical options, trends indicate that anatomic joint preservation arthroplasty procedures are quickly becoming the preferred treatment method over traditional total joint replacements.
 
In my opinion, the demand for joint preservation procedures will continue well beyond 2020, driven by the fact that fitness and an active way of life are now priorities for many people. Accordingly, as the population ages, we are seeing more and more patients who want to return to normal activity levels post-operatively. Anatomic joint preservation procedures recreate the native shape of the joint, remove minimal bone, and minimize wear and loosening so after surgery, patients can be pain-free and regain their active lifestyles.
 
During joint preservation surgery, bone is preserved while the joint surface (damaged area) is replaced to restore normal anatomy. For instance, the newer aspherical stemless shoulder arthroplasty systems with inlay glenoid implants are particularly well-suited for primary arthroplasty. In addition to the shoulder, anatomic implant systems are also available for the knee, wrist, and toe. Compared to traditional total joint replacements, these joint preservation procedures offer a range of benefits, including a shorter operative time, a lower risk of periprosthetic fracture, diaphyseal bone preservation, and an easier revision compared with stemmed arthroplasty.  
 
Benefits of The Joint Preservation Procedure
Recent research conducted by the Department of Orthopedic Surgery at The Cleveland Clinic Foundation found that joint preservation arthroplasty for the shoulder, particularly when using the OVO with Inlay Glenoid Shoulder Arthroplasty System from Arthrosurface, relieved pain and increased range of motion in patients with glenohumeral arthritis. However, when traditional total joint replacement is used for patients with this condition, the humeral head, rotator cuff, and significant amounts of bone and surrounding joint structures are removed resulting in a very invasive traditional TSA (total shoulder arthroplasty). As a result, traditional total shoulder replacement surgery creates an artificial joint, one that often does not feel “normal” and can limit range of motion during certain activities, such as weightlifting, throwing, and engaging in contact sports.
 
By contrast, the joint preservation procedure studied in the research restores the shoulder joint less invasively and without removing as much cartilage and bone. That’s possible because this innovative arthroplasty system uses a humeral implant designed with an aspherical head that replicates the patient’s native anatomy and can be custom matched and fit to their joint size and shape. The humeral implant is coupled with a unique glenoid implant that is inlayed into the bone (rather than on top), preserving natural bone to support it around its edges and leaving the natural shape of the joint intact. This positioning better distributes the forces between the inlay component and the native glenoid and is ultimately what provides superior range of motion postoperatively. In addition, significantly less cartilage and bone are removed compared to traditional joint replacements, and the joint is less surgically altered (which can provide more options should future surgery be required). As might be expected, patients undergoing joint preservation surgery spend less time in the hospital; in fact, many of these procedures can be performed on an outpatient basis.
 
Results from the Study
Of the 31 shoulders studied, there were no intraoperative complications and no 90-day re-hospitalizations. The results showed excellent pain relief, satisfaction, and functional results for both eccentric and concentric glenoids, as well as significant improvement in Penn Scores and improved range of motion compared to traditional stemmed total shoulder arthroplasty in conventional or reverse configurations.
 
Conclusion
Although relatively new to the arthroplasty landscape, anatomic joint preservation systems like the one reviewed in the study have been stable constructs with no reported loosening over the last 14 years. Compared to traditional total joint replacement, they offer less-invasive, bone-preserving, and better force-distributing joint repair—and that is why they are becoming increasingly preferred by a growing number of patients and surgeons alike.
 
Perhaps most importantly—and just as the name implies—joint preservation surgery preserves motion and the native anatomy of the joint, resulting in no activity restrictions. That makes these procedures particularly appealing to those who want to resume activities and sports that are typically prohibited after traditional joint arthroplasty. Advances like anatomic joint preservation help ensure that our aging population can maintain active, healthy lifestyles for years to come.
 

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Kevin Farmer, MD, is an associate professor at the University of Florida Department of Orthopaedics and Rehabilitation in Gainesville, Florida. He also serves as a team physician for the UF Athletic Association.