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Joint preservation vs. replacement: Be informed, make best decision for patients
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Joint replacement is more popular than joint preservation. Many people consider it the ultimate solution for a wide range of conditions and diseases affecting the joints, but mainly the hips and knees. Orthopaedic surgeons and manufacturers have also played a major role in the popularity of joint replacement surgery.
There is no way back for the surgeon or patient once the bone has been cut during joint replacement surgery. Therefore, as one of several mandatory steps before recommending a total joint replacement, we, as orthopaedic surgeons, need to inform our patients about joint preservation as either the recommended treatment or an alternative approach to consider.
Be familiar with joint preservation
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In specific cases and for some widely recognized conditions, joint replacement is unquestionably the treatment of choice. But, I think most orthopaedic surgeons have insufficient education in and knowledge about the many alternatives to joint replacement, in particular, joint preserving procedures and their outcomes. Since we have not taken the time to familiarize ourselves with these non-arthroplasty approaches, we simply turn to the familiar treatment, which is usually arthroplasty.
Procedure frequency
Per Kjaersgaard-Andersen
The frequency with which joint preservation procedures are performed also lags behind joint arthroplasty because many patients eventually revisit us because they require a joint replacement. Therefore, we conclude that patients should not have a wait-and-see period following a joint preservation procedure when they could have experienced the pain-free benefits of a replacement procedure a lot earlier. So we decide more often than not that a total joint replacement is indicated in this population.
Economic factors affect the adoption of joint preservation procedures as well. Joint replacement surgery provides greater financial benefit for surgeons and hospitals than joint preservation, which may become a financial incentive to perform these procedures.
More orthopaedic education programs should focus on joint preservation techniques to increase knowledge about the alternatives to joint reconstruction. Without such information, surgeons will not select the less-invasive procedures.
Orthopaedic surgeons should have to regularly pass a board examination to assess their knowledge in joint preservation as a requirement to keep their licenses to practice orthopaedics. Finally, there should be clear and approved international guidelines for both joint replacement and joint preservation procedures that are recognized by orthopaedic organizations, such as the European Federation of National Associations of Orthopaedics and Traumatology and the American Academy of Orthopaedic Surgeons. Joint preservation education also should be emphasized at their annual meetings.
Above all, when diagnosing a joint problem and deciding on the best course of treatment, orthopaedic surgeons need to remember that just because they can do a procedure does not necessarily make it the best option for the patient.