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Long-term osteochondral allograft findings reveal widespread use, predictors of failure
SAN DIEGO — Two analyses of one surgeon’s 25-year experience with knee osteochondral allografting, presented here at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons, showed that 72 of 354 grafting procedures with 2-year minimum follow-up failed at a mean follow-up of 40 months. However, postoperative survivorship at 5 and 10 years was 82% and 72% respectively.
 William D. Bugbee |
“It is a small cohort at 25 years,” said William D. Bugbee, MD, of Scripps Clinic Torrey Pines in La Jolla, Calif., who presented both studies.
“The lowest failure rate is in osteochondritis dissecans at 11%, and the highest failure rate is with the diagnosis of osteoarthritis at 47%,” he said.
The survivorship of cases with osteochondritis dissecans exceeded 80% at all time points compared with cases with osteoarthritis (OA), which showed survivorship of less than 40% at 10 years postoperatively.
During the discussion period, however, Bugbee said that OA diagnosis as a prognostic factor was more likely a consequence of the condition combined with advanced age than anything else, since he has successfully treated patients with OA who were in their 20s with this technique.
Bugbee concluded, “Allografting was a successful and useful treatment for widespread knee pathology with clinically reported objective and subjective improvement and a remarkably high rate of patient satisfaction.”
Bugbee and his colleagues’ investigation of predictors of osteochondral allograft failure in the second study demonstrated that female gender, age great than 40 years and grafts larger than 10 cm2 were prognostic factors for poorer outcomes. “All predicted graft failure,” Bugbee said.
“Surprisingly and provocatively, diagnosis and graft location did not predict outcome in this model,” he added.
References:
- Bugbee WD, et al. Twenty-five year experience with osteochondral allografting of the knee. Paper #197. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.
- Bugbee WD, et al. Predictors of osteochondral allograft failure. Paper #202. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.
Disclosure: Bugbee is a consultant to Joint Restoration Foundation and Zimmer.
To be honest, nothing really works and there are so many different treatment options. Everyone is saying what the truth is but, in the end, it is difficult to compare. Now what is evolving is that you have close indications for certain cartilage treatments depending also on the comorbidities of the patient. Location-dependent is definitely the industry guidance.
The problem with the longer follow-up is that quite a considerable amount is being lost because you can’t follow a patient 25 years. It is a remarkable thing that he accomplished, that he was able to follow a couple of his patients, but the statistical significance drops very much when you lose so many patients over a period of time. The solution I think would be to create a registry, but that is just very expensive and needs to be a government driven.
– Arvind von Keudell, MD
Sports medicine, Brigham and Women’s Hospital
Boston
Disclosure: He has no relevant financial disclosures.
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