Friday, April 25, 2014

I'm 51-years old and very active physically. I've had a bad hole in my knee cartilage that the orthopedic surgeon agreed to repair with a cartilage transplantation. It didn't take the first time, so we tried it again. Now, I have too much cartilage growth so they have to do another revision surgery to scrape the extra lump of cartilage away. I was warned my age could be against me. Do younger patients have any of these kinds of problems?

Age has been an issue when considering the merits of chondrocyte implantation. This type of treatment is used for cartilage defects that cause pain and loss of knee function. Studies on the use of chondrocyte implantation among older adults are very limited. This is due, in part, to the notion that by age 45 or older, the patient would do better to have a total knee replacement instead of chondrocyte implantation. Recovery is faster with fewer problems.

But newer studies comparing results in younger versus older (over 45 years old) age groups have shown similar results no matter how old the patient was. So, age may not be the key factor after all. Of course, there may be a particular age after which chondrocyte implantation just isn't as good of a treatment approach as joint replacement. But further studies will be needed to identify just where is the cut off age for success versus failure.

Anyone (young or old) who is thinking about having chondrocyte implantation for cartilage defects should be told about possible complications. Besides graft failure, one of the most common problems is overgrowth of the implanted cells called hypertrophy.

A second challenging problem is the formation of adhesions (fibrous scar tissue). Both of these complications requires a second surgery to correct the problem. As many as one-third of all ACI patients end up having a second arthroscopic procedure. They call this a second-look arthroscopy. The excess tissue is shaved away or removed, providing long-lasting positive results.

Surgeons in Europe have solved this problem by replacing the periosteal cover used to protect the implant with a new collagen membrane. This new patch is not yet available in the United States. In the meantime, careful patient selection (young or old) remains a key factor in the success of the ACI procedure. Age does not have to be an immediate strike against the patient. Obesity, noncompliance with the rehab program, tobacco use, and loss of joint space are major risk factors for failure. Such patients must be screened for and excluded from this type of surgery.

Reference:

Ralf E. Rosenberger, MD, et al. Repair of Large Chondral Defects of the Knee with Autologous Chondrocyte Implantation in Patients 45 Years or Older. In The American Journal of Sports Medicine. December 2008. vol. 36. No. 12. Pp. 2336-2344.'

This is an excerpt from eOrthopod.com, a website providing patients with clear, accurate and understandable information about their orthopedic and musculoskeletal conditions and injuries. eOrthopod.com includes a comprehensive library of multimedia web topics, news articles and FAQ database on musculoskeletal health. eOrthopod.com also hosts eOrthopodTV, in depth video interviews with practicing clinicians about the evaluation and treatment of common conditions and injuries of the muscles, bones and joints. For more information, visit eOrthopod.com.