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For cartilage repair to halt OA progression, it must address subchondral bone status
Researchers believe early OA does not inhibit cartilage formation and could actually enhance it.
The orthopaedic operating rooms of tomorrow may accommodate more cartilage repair procedures being done to treat osteoarthritis and stop its progress better than joint replacement arthroplasties, Anthony P. Hollander, PhD, a professor and cartilage researcher at the University of Bristol, England, has predicted.
Research into this new cartilage repair approach is in its early stages. But Hollander said an increasing amount of work is now being performed into what he described as a more extensive and thorough repair of the overall joint damage inflicted by osteoarthritis (OA), rather than just the cartilage.
To date, research Hollander and his colleagues have conducted in this area has convinced him of one thing: For a cartilage regeneration strategy to ultimately succeed in “curing” a patient’s knee or hip osteoarthritis, it must go beyond repairing only the cartilage damage that appears on the articular surface of a joint in the form of focal defects.
“Why just repair the cartilage, when the bone is the problem?” Hollander asked during a presentation he made at the 7th World Congress of the International Cartilage Repair Society in Warsaw.
Subchondral bone
In discussing whether regenerated cartilage can slow down the overall osteoarthritic disease process, Hollander said it is possible. Cells employed in cartilage repair techniques being used clinically today, such as autologous cultured chondrocytes or stem cells, are extremely active.
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“They are going to be talking to that subchondral bone and orchestrating a repair process that may well involve the bone,” he said.
Hollander reminded congress attendees that subchondral bone cannot be ignored in this process. In particular, stop thinking about plugs and grafts that repair cartilage as a passive tissue, he said. “We should see these implants as having the potential not just to regenerate new cartilage, but for orchestrating a repair process that affects all the tissues in the joint and possibly the soft tissues as well,” Hollander noted.
Treat early
Hollander also offered this encouraging news: “Cartilage formation is not inhibited by this early osteoarthritic process and may possibly be enhanced by it.” His group’s research produced findings supporting that concept, which are detailed in a study published in Tissue Engineering in 2006.
When it comes to treating patients, orthopaedic surgeons and others may still need to treat them early with stabilization, osteotomy and other techniques. “We don’t know if regenerated cartilage can slow down osteoarthritis, but being early can have an effect on the cartilage as well as the whole joint,” Hollander explained.
“We should see this as a balance between degradation and synthesis,” he added.
For more information:
- Anthony P. Hollander, PhD, the Arthritis Research Campaign (ARC) professor of rheumatology and tissue engineering, Dept. of Cellular & Molecular Medicine, can be reached at University of Bristol, the School of Medical Sciences, School of Medical Sciences, University Walk, Clifton, Bristol, BS8 1TD, England; +44-117-33-12403; e-mail: A.Hollander@bristol.ac.uk. He received financial support from ARC, BBSRC, EU Framework programs 5 and 6.
References:
- Hollander AP, Dickinson SC, Sims TJ, et al. Maturation and integration of tissue engineered cartilage implanted in injured and osteoarthritic human knees. Tissue Eng. 2006;12:1787-1798.
- Hollander AP, Kafienah WZ, Wylde V, Blom A. Will regenerated cartilage slow down the disease process in osteoarthritis? #8.2. Presented at the 7th World Congress of the International Cartilage Repair Society. Sept. 29-Oct. 2, 2007. Warsaw.