Biologic Joint Repair May Delay Artificial Knee Joint Replacement

A new study indicates that arthritic patients can forestall, or in some cases, avoid, total knee replacement with artificial joints by opting for meniscal allograft transplantations performed concurrently with articular cartilage repair.

Researchers at the Stone Research Foundation (San Francisco, CA, USA) followed 119 meniscal allograft transplantations performed concurrently with articular cartilage repair in 115 patients with severe articular cartilage damage; 53 (46.1%) of the patients were over the age of 50 at the time of surgery. Mean follow-up was for 5.8 years, with 25 procedures (20.1%) failing at a mean of 4.6 years; of these, 18 progressed to knee replacement at a mean of 5.1 years. Estimated mean survival time for the whole series was 9.9 years.

Using Cox's proportional hazards model, the researchers assessed the effect of covariates on survival, with age at the time of surgery and the number of previous operations found to be significant. The survival of the transplant was not affected by gender, the severity of cartilage damage, axial alignment, the degree of narrowing of the joint space or medial versus lateral allograft transplantation. The patients experienced significant improvements at all periods of follow-up in subjective outcome measures of pain, activity, and function. The study was published in the July 2010 issue of the British Journal of Bone & Joint Surgery.

"Meniscal allograft transplantation, when combined with articular cartilage repair, need not be limited to young patients with minimal articular cartilage damage, as demonstrated by the results of this study,” said lead author Kevin Stone, M.D., and colleagues. "Biological joint reconstruction may be an appropriate first step for many people with arthritis of the knee.”

Loss of the meniscus generates increased forces on the articular cartilage of the knee and other joint structures and increases the risk of the development of arthritis. Current treatment for loss of the meniscus with unicompartmental arthritis remains controversial, with treatments including osteotomy, unicompartmental knee replacement (UKR), or total knee replacement. Biological treatment, such as meniscal allograft transplantation and articular cartilage repair, might potentially slow the progression of arthritis without limiting the option for arthroplasty in the future.

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Stone Research Foundation