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Biologic joint reconstruction using stem cells proven successful in patients with arthritis
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Biologic joint reconstruction, rather than bionic replacement, may be an appropriate first step for many people with knee joint arthritis, according to recently presented research results.
The procedure, as presented, involves combining articular cartilage repair techniques – such as stem cell paste grafting – with meniscus allograft replacement.
Kevin R. Stone, MD, made his presentation at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons, in New Orleans.
“The most common request in my office is, ‘Hey doc, isn’t there just a shock absorber you could put in my knee to just buy me some time?’” Stone said. “The traditional thought has been that meniscus replacement cannot work in arthritic knees. The current thought, I believe, is that meniscus transplantation does work in arthritic knees – if you treat the damaged articular cartilage.”
Study parameters
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Stone’s study was a long-term meniscus allograft follow-up involving 115 patients (119 cases) with severely damaged articular cartilage. Patients underwent a combined meniscus allograft transplantation and articular cartilage repair, and were followed for an average of 5.8 years. Patients reported their pain, activity, and function levels using validated subjective outcomes assessments before surgery and then at 2, 3, 5, 7, 10 and 12 years after surgery.
Stone said significant improvements in pain, activity and function were found over the course of follow-up, indicating that patients improve significantly within the first 2 years after surgery and that these improvements are maintained over time.
A Kaplan-Meier survival analysis calculated the average procedure survival time at 9.93 years.
“This is the longest – that we know of – study for meniscus transplantation in arthritic knees only,” Stone said.
Malalignment’s impact on failure
Procedure failure was defined by Stone’s group as a progression to artificial joint replacement or removal of the allograft without revision. Revision meniscus allograft transplantation was carried out in 8 cases (6.7%). Only 1 of these cases ultimately failed. Twenty-five of the 119 meniscus allograft transplantations (20.1%) failed with a mean failure time of 4.65 years.
“The most important variables are age and the number of previous surgeries,” Stone said. “Not related is malalignment severity or joint space narrowing. So the patient coming in to you with varus and medial joint space narrowing is not contraindicated to have a meniscal allograft based on this data.”
Age has little effect
Increased age and number of previous surgeries increased the risk of failure, but only slightly. Sixty-six patients in the study were younger than 50 years of age at the time of surgery, with an average age of 39. Fifty-three patients were older than 50 years with an average age of 56. Average procedure survival time for a 39-year-old patient was calculated at 10.7 years. For a 56-year-old patient it was calculated at 8.8 years.
“The number of total joint surgeries is rapidly increasing,” Stone concluded. “If you can buy your patient even 5 years for a 50-, 60- or 70-year-old who still wants to play sports, we think that is a cost-effective decision to make. We think that will be true for biologic versus bionic replacement.”
- Reference:
Stone KR, Walgenbach A, Adelson WS, et al. Long-term survival of concurrent meniscus allograft transplantation and articular cartilage repair. Paper #575. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13. New Orleans.
