Joint-Preserving Surgeries: Who Are They For?

The Step Before a Joint Replacement

In orthopedic treatment, the primary goal is to preserve the patient’s natural joint for as long as possible. Joint-preserving surgeries are designed to achieve exactly that. Instead of replacing the entire joint—as is done in prosthetic surgeries—these procedures aim to correct structural issues, optimize load distribution, and slow down cartilage degeneration. They are particularly beneficial for younger, active individuals who are not yet ideal candidates for total joint replacement.

In this article, we take an in-depth look at what joint-preserving surgeries involve, which conditions they treat, and which patients benefit most from them.

What Is a Joint-Preserving Surgery?

Joint-preserving surgery refers to a group of surgical techniques that aim to maintain and protect the patient’s native joint rather than replace it. These techniques include procedures such as osteotomies (realigning bones to redistribute joint stress), cartilage repair techniques (e.g., microfracture, mosaicplasty), ligament reconstructions, and meniscus repairs.

By addressing the source of mechanical stress or instability, these surgeries can relieve pain, improve function, and delay the need for a joint replacement in the future.

When Are These Surgeries Preferred?

Joint-preserving surgeries are often recommended in the following scenarios:

1. Unicompartmental Knee Osteoarthritis:
When only one side of the knee is affected (usually the medial compartment), surgeries like high tibial osteotomy or distal femoral osteotomy can correct alignment and shift weight away from the damaged cartilage.

2. Hip Dysplasia:
In patients with shallow acetabulums, a periacetabular osteotomy (PAO) can improve coverage of the femoral head and reduce joint degeneration.

3. Femoroacetabular Impingement (FAI):
For patients with bone impingement in the hip joint, arthroscopic surgery can reshape the femoral head-neck junction and preserve the labrum and cartilage.

4. Meniscus and Ligament Injuries:
Meniscal repair and cruciate ligament reconstruction protect the knee from future degeneration and restore joint stability.

5. Focal Cartilage Lesions:
When small, localized cartilage damage is detected early, procedures such as microfracture, osteochondral grafting, or stem cell applications can promote cartilage healing and regeneration.

In all these cases, the focus is on preserving as much natural joint function as possible, avoiding—or at least delaying—the need for prosthetic surgery.

Who Is a Good Candidate?

Successful outcomes depend largely on proper patient selection. Ideal candidates for joint-preserving surgeries include:

• Young and active adults (typically aged 20–50)
• Patients with localized joint pain and mechanical symptoms
• Those with partial cartilage damage and preserved joint space
• Individuals with alignment issues causing uneven load distribution
• Patients who have not responded to conservative treatments but are too young for joint replacement

With early intervention, these patients can maintain a high quality of life and extend the functional lifespan of their joints by many years.

Who Is Not a Suitable Candidate?

Joint-preserving procedures are less effective in patients with advanced degeneration. These procedures may not be appropriate for:

• Patients over 65 with low activity levels
• Individuals with diffuse cartilage loss across the joint
• Those with severe deformities or bone-on-bone arthritis
• Patients with significant osteoporosis or inflammatory arthritis

In such cases, total joint replacement often provides better long-term outcomes and functional improvement.

Factors That Affect Surgical Success

The success of joint-preserving surgery depends not only on the procedure itself but also on various patient-related and postoperative factors:

• Accurate diagnosis and timing
• Preoperative joint condition and muscle strength
• Surgeon experience and technique
• Adherence to physical therapy and rehabilitation
• Patient motivation and realistic expectations

With proper planning, experienced surgical care, and commitment to rehab, patients can achieve excellent long-term outcomes without needing a prosthesis.