Many orthopedic surgeons are looking beyond traditional methods of operation to incorporate new minimally invasive and biologic technology when treating their patients. For patients with knee damage, the most recent technology includes utilizing a combination of a natural bone and cartilage to stimulate a cadaver meniscus in order to relieve the patient's pain.
The procedure is performed in two parts: First the physicians remove bone and cartilage matter from the patient's knee and grind it into a paste; then, the paste is spread on the defect in the knee to stimulate cartilage growth and the meniscus is replaced with the cadaver meniscus.
With cartilage damage a "pothole" is created on the smooth articulating surface of the knee. The physician fills this defect with cartilage paste harvested from the patient's knee.
"As a pain specialist, I am familiar with biologic knee replacements and have seen patients with late-stage knee osteoarthritis need this procedure. It is my understanding that with this procedure you're using the patient's own tissue and you're putting it back in their own knee," says Charles Argoff, MD, a professor of Neurology at Albany Medical College and director of the Comprehensive Pain Program of Albany Medical Center in New York.
Appropriate patient type
Not every patient is a good candidate for biologic knee replacement surgery. The appropriate patient should be active and athletic, in the middle age range and not have bone-on-bone damage.
"In many ways, the appropriate patient is still being defined, since the area of biologic knee replacements is evolving both in science and technology," says James Gladstone, MD, co-chief of sports medicine and assistant professor of orthopedic surgery at Mount Sinai Medical Center in New York City. "Patients in the middle age range are the most appropriate. If you can take a patient who is 40 or 50 and restore a good and active quality of life before they need knee replacement, then I think you've done them a huge service."
Dr. Argoff says biologic knee replacements are most common among people with significant degeneration and an unstable joint.
"If I have a 23-year-old athlete or college triathlete and they have an isolated cartilage spot, and OTC medications, prescription medications and non surgical options have not worked, I may recommend they consider a biologic cartilage treatment," says Dr. Argoff.
Dr. Argoff says biologic knee replacements are most common among "weekend warriors": middle-aged individuals who participate in athletic activity during their weekends away from work. He has experienced success with younger patients as well.
Older patients suffering from severe arthritis are not well suited for this type of procedure, says Dr. Gladstone. Using the biological approach would not relieve their pain because these patients need a total knee replacement.
Procedure reimbursement
As biological knee replacement is a relatively new procedure, Dr. Argoff says some payors will not cover the procedure. He says performing biological knee replacement is cost-effective for the physicians if the insurance will pay for the procedure.
"With people living longer and continuing to want to live an active lifestyle, the need for knee pain management will continue to grow," says Dr. Argoff. "If insurance companies start realizing they should cover biologic knee replacements, more patients would benefit from it."
However, Dr. Gladstone has had less trouble receiving compensation from payors for the biological knee replacements he performs.
"Generally speaking, I've found biological knee surgery to be covered by the insurance," says Dr. Gladstone. "You have to present it appropriately and convincingly and get all the facts straight."
Advantages and disadvantages of biologics
A total knee replacement can be a debilitating experience for some patients and have a long recovery period. For patients who do not necessarily need a total knee replacement but are still experiencing pain, the biological treatment is a less-expensive substitute for the total operation. Receiving a biological knee replacement has the potential to delay a patient's need for total knee replacement and possibly obviate it all together.
"There are many people who are several years out from biologic knee replacement surgery and essentially they have been able to return to all activities after the biologic treatment," says Dr. Gladstone.
However, the biologic treatment does not guarantee the patient will not need total knee replacement surgery even in the near future.
"We're worried about the reliability in this procedure. The important thing is to optimize treatment options and make sure we understand the best choice for each patient," says Dr. Argoff.
"You are making the decision to do this massive surgery that will probably work," says Dr. Gladstone. "The patient is not guaranteed he or she won't need a knee replacement. This is where selecting the appropriate patients for biologic replacement plays a crucial role."
Most studies of biological knee replacement patients have not been able to track the long-term effects of the procedure. As a result, the effectiveness of biological knee replacement long-term is not known.
Additionally, Dr. Gladstone also says the rehabilitation program for patients receiving the biological knee replacement is different from the rehabilitation for other knee surgery procedures, often taking patients longer to recover. Biological knee replacement patients cannot begin full weight bearing immediately, as can total knee replacement patients, so the recovery time is usually extended.
Read more about biological joint replacement:
- Study: Biologic Knee Replacement Could Most Efficiently Slow Arthritis Progression
- Celling Launches Res-Q for Isolation of Adult Stem Cells for Bone Growth
- Stem Cell Therapy Research for Osteoarthritis Will Be Conducted in the UK
The procedure is performed in two parts: First the physicians remove bone and cartilage matter from the patient's knee and grind it into a paste; then, the paste is spread on the defect in the knee to stimulate cartilage growth and the meniscus is replaced with the cadaver meniscus.
With cartilage damage a "pothole" is created on the smooth articulating surface of the knee. The physician fills this defect with cartilage paste harvested from the patient's knee.
"As a pain specialist, I am familiar with biologic knee replacements and have seen patients with late-stage knee osteoarthritis need this procedure. It is my understanding that with this procedure you're using the patient's own tissue and you're putting it back in their own knee," says Charles Argoff, MD, a professor of Neurology at Albany Medical College and director of the Comprehensive Pain Program of Albany Medical Center in New York.
Appropriate patient type
Not every patient is a good candidate for biologic knee replacement surgery. The appropriate patient should be active and athletic, in the middle age range and not have bone-on-bone damage.
"In many ways, the appropriate patient is still being defined, since the area of biologic knee replacements is evolving both in science and technology," says James Gladstone, MD, co-chief of sports medicine and assistant professor of orthopedic surgery at Mount Sinai Medical Center in New York City. "Patients in the middle age range are the most appropriate. If you can take a patient who is 40 or 50 and restore a good and active quality of life before they need knee replacement, then I think you've done them a huge service."
Dr. Argoff says biologic knee replacements are most common among people with significant degeneration and an unstable joint.
"If I have a 23-year-old athlete or college triathlete and they have an isolated cartilage spot, and OTC medications, prescription medications and non surgical options have not worked, I may recommend they consider a biologic cartilage treatment," says Dr. Argoff.
Dr. Argoff says biologic knee replacements are most common among "weekend warriors": middle-aged individuals who participate in athletic activity during their weekends away from work. He has experienced success with younger patients as well.
Older patients suffering from severe arthritis are not well suited for this type of procedure, says Dr. Gladstone. Using the biological approach would not relieve their pain because these patients need a total knee replacement.
Procedure reimbursement
As biological knee replacement is a relatively new procedure, Dr. Argoff says some payors will not cover the procedure. He says performing biological knee replacement is cost-effective for the physicians if the insurance will pay for the procedure.
"With people living longer and continuing to want to live an active lifestyle, the need for knee pain management will continue to grow," says Dr. Argoff. "If insurance companies start realizing they should cover biologic knee replacements, more patients would benefit from it."
However, Dr. Gladstone has had less trouble receiving compensation from payors for the biological knee replacements he performs.
"Generally speaking, I've found biological knee surgery to be covered by the insurance," says Dr. Gladstone. "You have to present it appropriately and convincingly and get all the facts straight."
Advantages and disadvantages of biologics
A total knee replacement can be a debilitating experience for some patients and have a long recovery period. For patients who do not necessarily need a total knee replacement but are still experiencing pain, the biological treatment is a less-expensive substitute for the total operation. Receiving a biological knee replacement has the potential to delay a patient's need for total knee replacement and possibly obviate it all together.
"There are many people who are several years out from biologic knee replacement surgery and essentially they have been able to return to all activities after the biologic treatment," says Dr. Gladstone.
However, the biologic treatment does not guarantee the patient will not need total knee replacement surgery even in the near future.
"We're worried about the reliability in this procedure. The important thing is to optimize treatment options and make sure we understand the best choice for each patient," says Dr. Argoff.
"You are making the decision to do this massive surgery that will probably work," says Dr. Gladstone. "The patient is not guaranteed he or she won't need a knee replacement. This is where selecting the appropriate patients for biologic replacement plays a crucial role."
Most studies of biological knee replacement patients have not been able to track the long-term effects of the procedure. As a result, the effectiveness of biological knee replacement long-term is not known.
Additionally, Dr. Gladstone also says the rehabilitation program for patients receiving the biological knee replacement is different from the rehabilitation for other knee surgery procedures, often taking patients longer to recover. Biological knee replacement patients cannot begin full weight bearing immediately, as can total knee replacement patients, so the recovery time is usually extended.
Read more about biological joint replacement:
- Study: Biologic Knee Replacement Could Most Efficiently Slow Arthritis Progression
- Celling Launches Res-Q for Isolation of Adult Stem Cells for Bone Growth
- Stem Cell Therapy Research for Osteoarthritis Will Be Conducted in the UK