For patients with deteriorating joints, the traditional advice has often been to manage the pain until it becomes unbearable enough to justify replacement. But what if waiting is part of the problem?
Marisa Seegobin, MD, a sports medicine surgeon at Boca Raton, Fla.-based Spine & Orthopedic Center, believes a growing understanding of what causes joints to deteriorate is challenging one of orthopedics’ most familiar treatment pathways.
Rather than treating arthritis as an inevitable consequence of aging, surgeons are increasingly identifying mechanical problems that can accelerate joint damage, and, in some cases, correcting them before replacement becomes necessary.
“The biggest thing is that we’re really trying to bridge the gap between injections and joint replacement,” Dr. Seegobin told Becker’s.
For active patients hoping to preserve their joints for decades, that gap represents both an opportunity and a difficult clinical question: How much damage can be reversed or managed before the window for preservation closes?
The joint doesn’t tell the whole story
During her training, Dr. Seegobin cared for athletes ranging from NFL players to collegiate competitors and professional dancers. Some of the most important lessons came from patients whose imaging seemed to contradict their physical abilities.
“I’ve seen NFL players whose shoulders look like they could be 80 years old, but they feel good,” she said.
An X-ray might suggest advanced deterioration, but replacing that shoulder could end an athlete’s ability to compete. Conversely, a patient with relatively unremarkable imaging may experience debilitating pain that warrants further investigation.
“You can’t treat the imaging,” she said.
That principle extends well beyond professional sports. Dr. Seegobin considers recreational athletes, older adults and anyone trying to maintain an active lifestyle part of the same conversation. Their injuries may resemble those of elite competitors, but their expectations for recovery can be entirely different.
It is also why she resists drawing a strict age cutoff for joint preservation. As older adults remain active longer, chronological age alone offers an increasingly incomplete picture of who might benefit.
The more consequential question is whether the surgeon can identify a correctable problem before the joint has deteriorated too far.
Why fixing one injury may not be enough
One of the most significant changes in joint preservation is a shift away from treating damaged structures in isolation.
A patient with a damaged meniscus, for example, may also have abnormal leg alignment or ligament instability. Replacing the meniscus without addressing those underlying problems can leave the transplanted tissue exposed to the same forces that contributed to the original damage.
Dr. Seegobin said surgeons are increasingly recognizing the importance of examining the entire limb, from hip to ankle, rather than concentrating exclusively on the site of pain.
“Don’t just look at the cartilage damage or the impingement. Look at the whole picture,” she said.
That broader evaluation can change the operation itself. A patient may need cartilage restoration alongside an alignment correction, or treatment of multiple abnormalities in one or more surgical procedures. The goal is not necessarily to perform more surgery. It is to identify which problems must be addressed for a preservation procedure to have a reasonable chance of lasting.
A similar approach is changing how surgeons manage certain hip conditions. In femoroacetabular impingement, abnormal contact between the femoral head and socket can damage the labrum and surrounding cartilage. Hip arthroscopy can address the impingement and repair damaged tissue, potentially delaying the need for replacement in appropriately selected patients.
For Dr. Seegobin, these advances reflect a larger change in how orthopedics understands arthritis.
“We used to think arthritis was just wear and tear from getting older, but we now know that’s not always the case,” she said.
Age remains important, but so do alignment, joint mechanics and previously untreated injuries. Understanding those relationships gives surgeons opportunities to intervene earlier rather than simply managing the consequences of progressive damage.
The promise, and limits, of buying time
The prospect of delaying joint replacement is particularly compelling for younger patients, but Dr. Seegobin cautions against promising a specific number of additional years.
When an underlying mechanical problem can be corrected, she hopes some preservation procedures may provide benefits lasting decades. Yet outcomes depend on the condition, the extent of existing damage and factors that surgeons still do not fully understand.
“There’s still so much we don’t know,” she said.
The distinction becomes especially important once arthritis is widespread. A patient may be young and highly motivated to avoid replacement, but severe diffuse degeneration can leave few viable preservation options.
Dr. Seegobin encounters patients in precisely that situation: They are younger than the typical joint replacement candidate, yet their disease has progressed beyond what current preservation techniques can reliably address.
Emerging biologic therapies offer another area of interest, although she believes enthusiasm must remain grounded in evidence. Platelet-rich plasma and stem cell-based treatments are attracting research attention, but Dr. Seegobin said their effectiveness varies by application, and evidence remains insufficient to support their use for every patient.
“I love the research. I think it’s super, super exciting,” she said. “Right now, however, it is still limited, so it’s not the right answer for everyone.”
The challenge for surgeons is not simply expanding the menu of available treatments. It is determining which interventions can meaningfully alter a patient’s course and which remain unproven.
When waiting becomes the wrong strategy
For all the advances in surgical techniques, Dr. Seegobin sees another obstacle to joint preservation: Patients often do not realize they may have options before replacement. Some have watched family members endure years of pain before undergoing surgery. Others assume injections and physical therapy are the only treatments available until their arthritis becomes severe.
As a result, they delay evaluation, sometimes while a potentially correctable problem continues to affect the joint. That assumption can be consequential. A mechanical abnormality that might be addressed earlier may become more difficult to treat after years of progressive degeneration.
Dr. Seegobin is not advocating surgery at the first sign of pain. She emphasizes physical therapy, rehabilitation, exercise and core strength as important parts of maintaining joint function and supporting recovery. Nor does she believe preservation should always take priority over replacement.
For an older patient whose primary goal is to relieve pain and return to basic activities, a joint replacement may offer a more straightforward recovery than a complex preservation procedure. The right decision depends on the patient’s symptoms, functional limitations and willingness to undergo rehabilitation, not simply how much native cartilage remains.
The opportunity before replacement
For Dr. Seegobin, who performs both joint preservation and replacement procedures, the challenge is identifying which patients can benefit from earlier intervention and when replacement remains the better option.
As patients stay active longer, she believes the greatest opportunity lies in recognizing and treating the underlying causes of joint deterioration before the damage becomes irreversible.
That starts with challenging the assumption that patients must wait until their pain becomes unbearable to seek answers.
“Get your diagnosis, see what’s going on, see what your options are,” she said. “Because you may be surprised by what you can do.”
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