Can You Avoid Joint Replacement in Dallas? Why I Want Women to Know They Have Options
By Deborah Westergaard, M.D. Dallas | Regen Experts Dallas & Plano
If your knee, hip, shoulder, or back has begun interfering with the life you want to live, joint replacement or spine surgery may not be your only option.
That is one reason I placed an advertisement in the September issue of D Magazine.
I wanted women across Dallas Fort Worth to know something that I believe many still have not been told:
There may be another conversation worth having before you accept that surgery is inevitable.
I have spent decades performing interventional spine and joint procedures. I completed fellowship training in Pain Medicine after my residency in Anesthesiology and am board certified in both Anesthesiology and Pain Medicine.
But there is another part of my experience that matters to me when I sit across from a patient.
I have been the patient.
I have undergone orthobiologic procedures myself.
My hip. My knee. My shoulder. My wrists and hands.
I have received PRP and bone marrow-based treatments, including treatment directed into subchondral bone.
So when a woman sits across from me wondering what a procedure will feel like, how difficult the recovery might be, or whether she should consider regenerative treatment before surgery, I understand that conversation from both sides of the needle.
That does not mean orthobiologics can eliminate the need for surgery.
They cannot.
But for an appropriately selected patient, they may provide another option worth evaluating.
Can You Avoid Joint Replacement in Dallas With Orthobiologics?
Some appropriately selected patients may be able to postpone or avoid joint replacement, but the answer depends on the joint, the underlying pathology, the severity of disease, alignment, bone involvement, and many other individual factors.
This is where regenerative medicine has become much more interesting to me.
Years ago, much of the discussion surrounding PRP and other biologic treatments focused on putting an injection into a painful joint.
Today, our understanding is becoming more sophisticated.
A joint is not simply cartilage.
It is an organ system composed of cartilage, subchondral bone, ligaments, tendons, capsule, meniscus or labrum, muscles, and other supporting structures.
When I evaluate a degenerative joint, I want to understand which structures are failing and why.
Then we can ask a much better question:
Can we treat the structures contributing to the problem rather than simply treating where it hurts?
What Do Long Term Studies Tell Us About Bone Marrow Treatment and Knee Replacement?
Some long term research suggests that subchondral bone marrow concentrate treatment may postpone knee replacement in selected patients with knee osteoarthritis.
One particularly interesting, randomized study published by Hernigou and colleagues in International Orthopaedics in 2021 followed patients for an average of approximately 15 years.
Each patient had osteoarthritis in both knees.
One knee received bone marrow concentrate in the subchondral bone of the femur and tibia. The other received the same biologic material as an intra articular injection.
At approximately 15 years, 12 of the 60 knees treated in the subchondral bone had undergone knee replacement compared with 42 of the 60 knees treated only inside the joint.
Another long term study followed 140 patients who were candidates for bilateral knee replacement. One knee was replaced while the other received subchondral bone marrow treatment.
At an average follow up of approximately 15 years, 25 of those 140 biologically treated knees had ultimately undergone knee replacement.
These results are intriguing.
They do not prove that bone marrow concentrate will prevent knee replacement in every patient. These studies involved specific populations, protocols and techniques, and results should not automatically be generalized to everyone with osteoarthritis.
But they raise an important question:
Before replacing an arthritic joint, should an appropriate patient at least understand whether joint preservation remains an option?
I believe the answer to that question deserves a thoughtful evaluation.
Why Did My Own Shoulder Change the Way I Talk to Patients?
My experience receiving orthobiologic treatment made me understand aspects of these procedures that medical training alone cannot teach.
Several years ago, a highly respected orthopedic shoulder surgeon looked at my shoulders and told me that I would probably eventually need both replaced.
At the time, based upon my imaging and what I understood about degenerative joint disease, I thought he might very well be right.
I waited.
As I became more deeply involved in orthobiologic medicine, my understanding of joint degeneration also changed.
When my right shoulder became symptomatic enough to warrant treatment, I chose an orthobiologic approach that included treatment of the bone as well as PRP directed toward selected soft tissue and joint structures.
That experience did something important.
It put me in the patient's chair.
There is enormous variability in how people experience these procedures. My experience cannot predict someone else's outcome, and I would never tell a patient that it could.
But when a patient asks me what the days following a procedure may be like, I am no longer answering solely from what I have observed in my patients.
I know what it is like to go through it myself.
Why Should Women Pay Attention to Joint Pain Before It Becomes Severe?
Persistent or recurrent joint pain deserves evaluation because pain can reflect structural problems that may progress even when symptoms temporarily improve.
Pain is information.
Sometimes it is something relatively simple.
Sometimes it is not.
A knee that intermittently aches may have meniscal degeneration, ligament laxity, cartilage loss or changes in the underlying bone.
A painful shoulder may involve the rotator cuff, biceps tendon, labrum, cartilage, AC joint or subchondral bone.
Back pain may originate from discs, facet joints, ligaments, muscles, endplates or combinations of structures.
The fact that the pain disappears for several weeks does not necessarily mean that the underlying problem disappeared with it.
This is why I would rather evaluate a joint while there are still reasonable options for preserving it than meet someone after the disease has progressed so far that replacement has become the only sensible choice.
Is Joint Replacement a Bad Treatment?
No. Joint replacement can be an excellent treatment when it is medically appropriate and other reasonable options are no longer sufficient.
I think this distinction is extremely important.
My goal is not to tell people never to have surgery.
My goal is to help patients avoid unnecessary or premature surgery when a reasonable joint preservation option exists.
Hip and knee replacements have restored mobility and quality of life for millions of people.
But they are still major operations.
Surgery carries risks associated with anesthesia, infection, blood loss, thromboembolic events and recovery.
Periprosthetic joint infection is uncommon, but when it occurs it can be extremely difficult to treat. Bacteria can form biofilms on implanted material, which can make infection more resistant to both the immune system and antibiotics.
Joint replacements can also be associated with periprosthetic fractures. These fractures can occur following falls and can be particularly challenging when bone quality is compromised.
None of this means that someone who needs a joint replacement should fear having one.
It means that preserving your natural joint, when medically reasonable, has value.
Why Does Physician Training Matter for Spine and Joint Orthobiologics?
Image guided spine and joint procedures require far more than knowing how to inject PRP or bone marrow concentrate.
This is especially important when we are talking about the spine.
Before allowing someone to perform a procedure near your spinal cord, nerve roots or other critical structures, I think it is entirely reasonable to ask:
What was this physician's residency training?
Did the physician complete an accredited fellowship involving interventional spine procedures?
Is the physician board certified in the relevant specialty?
How many years has the physician performed image guided procedures?
What imaging guidance will be used?
How was the physician trained to manage complications?
There is an enormous difference between learning a procedure during a short training course and spending a year in fellowship training performing procedures under the direct supervision of experienced specialists.
My own fellowship training was followed by decades of performing image guided spine and joint procedures.
Precision matters.
Experience matters.
And knowing when not to perform a procedure matters just as much.
Why Did I Put This Message in D Magazine?
Because I wanted women throughout Dallas Fort Worth to know that joint replacement and spine surgery are not always the first or only conversations available to them.
Many of the women I meet have spent decades building careers, families, businesses and lives they value.
They travel.
They exercise.
They play tennis or pickleball.
They ski.
They garden.
They take care of grandchildren.
They run companies.
They simply want to get out of a chair, walk through an airport or climb a staircase without thinking about their knee every step of the way.
Getting older does not mean becoming indifferent to how well your body functions.
And wanting to preserve your mobility is not vanity.
It is independence.
It is resilience.
It is quality of life.
That is why I wanted the women reading D Magazine to know that there is a female physician here in Dallas who has spent decades treating spine and joint conditions and who has also personally faced some of the same decisions.
I know what it is like to look at an MRI of your own joint.
I know what it is like to wonder what the next several years will bring.
And I know what it is like to choose an orthobiologic procedure for myself.
What Should You Do If Your Knee, Shoulder, Hip or Back Keeps Hurting?
Do not wait until pain has taken away the activities that matter to you before finding out what is causing it.
An evaluation does not obligate you to have a procedure.
It gives you information.
Sometimes I tell a patient that an orthobiologic procedure is reasonable.
Sometimes I tell a patient to wait.
And sometimes the appropriate recommendation is orthopedic surgery.
The objective is not to sell every patient a procedure.
The objective is to understand the problem well enough to choose an appropriate path forward.
If you live in Dallas, North Dallas, Preston Center, Plano or elsewhere in the Dallas Fort Worth area and have been told that joint replacement or spine surgery may be in your future, consider obtaining a comprehensive joint preservation or spine evaluation before assuming that surgery is inevitable.
Your first decision does not have to be which operation to have.
It can simply be understanding all of your options.
Frequently Asked Questions About Avoiding Joint Replacement in Dallas
Can PRP help me avoid joint replacement?
PRP may improve symptoms and function in appropriately selected musculoskeletal conditions, but it cannot guarantee that someone will avoid joint replacement. The diagnosis, severity of degeneration and structures involved all matter.
Can bone marrow concentrate prevent a knee replacement?
Long term studies have reported delayed or avoided knee arthroplasty in selected patients treated with subchondral bone marrow concentrate, but these findings should not be interpreted as a guarantee for an individual patient.
What is subchondral bone?
Subchondral bone is the bone immediately beneath the cartilage of a joint. Osteoarthritis involves more than cartilage, and abnormalities within this underlying bone may be important in some patients.
What is bone augmentation?
In my practice, bone augmentation refers to image guided placement of an autologous orthobiologic preparation into specifically selected areas of subchondral bone when the patient's diagnosis and imaging make that target appropriate.
Is PRP the same as bone marrow concentrate?
No. Both are autologous, meaning they are prepared from the patient's own body, but they have different compositions and may be selected for different tissues and clinical situations.
Are regenerative procedures FDA approved to treat osteoarthritis?
Autologous orthobiologic procedures exist within a complex regulatory framework, and patients should not interpret the term regenerative medicine as meaning that a product is FDA approved to cure or regenerate an arthritic joint. Treatment claims should be discussed specifically with the treating physician.
Is joint replacement sometimes the right choice?
Absolutely. For some patients, joint replacement is the most appropriate treatment. Joint preservation is about determining whether a reasonable alternative exists before surgery, not opposing surgery when surgery is indicated.
Who should perform regenerative spine procedures?
Patients considering spine orthobiologics should carefully evaluate a physician's residency, fellowship training, board certification, image guidance experience and experience performing interventional spine procedures.
Where can I get an orthobiologic evaluation in Dallas or Plano?
Regen Experts evaluates patients seeking physician led, image guided orthobiologic options for joint and spine conditions in the Dallas and Plano area. An evaluation is designed to determine the structures involved and whether regenerative treatment, continued conservative care or surgical consultation is most appropriate.
References
Hernigou P, et al. Subchondral bone or intra articular injection of bone marrow concentrate mesenchymal stem cells in bilateral knee osteoarthritis: what better postpone knee arthroplasty at fifteen years? International Orthopaedics. 2021;45:391–399.
Hernigou P, et al. Human bone marrow mesenchymal stem cell injection in subchondral lesions of knee osteoarthritis: a prospective randomized study versus contralateral arthroplasty at a mean fifteen year follow up. 2020.
Ward SA, et al. Innovations in the Isolation and Treatment of Biofilms in Periprosthetic Joint Infection. Orthopedic Clinics of North America. 2024;55:171–180.
Lombardo DJ, et al. Periprosthetic fractures about total knee arthroplasty. Journal of Orthopaedics and Traumatology. 2020.
Medical Disclaimer
This article is for educational purposes and does not constitute individual medical advice. Orthobiologic treatments are not appropriate for every patient, and outcomes vary. No treatment can guarantee avoidance of surgery or restoration of damaged tissue. A physician should evaluate the individual diagnosis, imaging, medical history, risks, benefits and reasonable alternatives before treatment.
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