Future of joint replacements by Dr.A.K.Venkatachalam
Future of Joint Replacements
Dr. A K Venkatchalam
MJRC Clinic, Chennai
Needle may replace scalpel
• Regenerative medicine is an exciting field in Orthopedics.
• Possible to treat Osteoarthritis of knee and hip with stem cells
injected through needle.
• This is possible by better understanding of the pathology of
We have the technology, we can rebuild him…
• PRP (Platelet-Rich Plasma)
• Stem cell treatment
• Tissue engineering
Joint preservation in knee
• Increasing role for osteotomies, meniscal replacement, meniscal
transplant, Osteochondral grafts, articular cartilage repair.
• The joint is not replaced but the abnormal biomechanics in and
around the joint are altered
• These may postpone the date for a knee replacement.
• Biological knee replacement possible with cadaveric menisci,
synthetic menisci, cadaveric ligaments, osteo-chondral grafts.
PRP (Platelet-Rich Plasma)
Cell therapies have even gone
beyond surgery to office-based
• Stem cells and growth factors,
such as PRP (Platelet-Rich
Plasma) are directly injected into
• The cell therapies are now also
being used experimentally in
conjunction with regenerative
surgeries to enhance, and
possibly accelerate the healing
Advances in Joint Replacement
• Newer materials which increase longevity of the implant.
• Cement-less fixation of knee implants.
• Smart tools like the I-Assist provide intra operative navigation.
• Validated soft tissue balancing tools – E-Libra
• Kinematically aligned knee replacement vs Mechanically
aligned knee replacement.
• Biological knee replacements – Can be done in incremental
steps in India with tissue bank assistance.
• Customized implants – These are available abroad.
• Femoral components made
of Oxidized zirconium
• Plastic tray made of highly
cross linked polyethylene.
• Vitamin E incorporated
durable poly inserts
Image-guided and Robotic Surgery
• Image-guided surgery (sometimes called computer-assisted
surgery) is a technique where surgery is performed with the
aid of computerized images.
• Latest disposable navigation devices are I Assist and Ortho
• Navigation may be useful in young patients
• Only about 1 in 100 knee operations are currently
performed in this way. Results so far suggest this technique
offers greater accuracy in positioning the new knee joint.
• However, there is no evidence that it leads to better
function or survival of a knee replacement.
Cementless Knee Replacements
• Cemented knee replacements have been the most popular so
far, but cement-less knee replacements are available
• Components with a coating which has tiny holes in or which is
made from crystal can be used. This allows the bone to grow
on to and bond directly to the component. It’s thought that
this could provide a longer-lasting bond than cement, which
may break down over time.
• However, there’s currently no evidence that the components
themselves are better in terms of pain relief, function, or how
long they last.
• Research continues into the pros and cons of cementless
versus cemented knee replacements.