Biologics is a new frontier for knee replacements and James Gladstone, MD, a sports medicine and orthopedic physician at Mount Sinai Medical Center in New York City, is at the cutting edge of this new technology. For healthy, active and middle-aged patients, this type of procedure can prolong the need for total knee replacement and allow patients a full recovery and return to their activities.
"There are a number of ways you can treat articular cartilage damage," says Dr. Gladstone. "The articular cartilage is like a smoothly paved road and inside of the road there's a pothole. When there's a pothole, the knee is exposed to extra stresses. If the patient feels more pressure, that’s when the patient starts experiencing pain. One option is microfracture. Microfracture puts small holes into the bone, accessing the bone marrow and blood supply. This creates a blood clot in the defect which recruitsi bone marrow stem cells, and growth factors."
Another option is cartilage cell transplantation where the knee’s healthy cartilage cells are harvested (sometimes grown in the lab) and then transplanted directly into the defect.
Dr. Gladstone is currently doing a study on the effectiveness of biologic knee replacement. He discusses some of the common concerns for physicians when deciding whether to perform biological knee replacements or the traditional total knee replacements.
Q: As a fairly new procedure, do you think the microfracture procedure will hold up over time?
Dr. James Gladstone: A number of more recent studies have shown that over time the fibrocartilge that forms may deteriorate. Another technique that is used is cartilage graft pasting. You harvest the cartilage and bones, mix the combination and place it into the defect. You're trying to activate cartilage cells and stem cells to repopulate the defect.
In most studies, the follow-up is not more than six years. What you would hope for ultimately would be a 20-year follow-up to show whether the cartilage integrity of the knee joint is upheld.
Q: Are there any advantages in biologic knee replacements as opposed to the traditional method of surgery?
JG: Biologic knee replacements are being done to people who have some pretty bad damage to their knee. These patients are missing the meniscus and portions of the cartilage. The encouraging thing is that studies show the biologic approach does seem to help. The biologic knee replacement can increase the time a patient has before they need a total knee replacement (TKR) and perhaps avoid a TKR altogether. Years ago, younger patients in pain had to wait for knee replacements, which have their own set of limitations.
Q: Is there a difference in the patient's recovery process with the biologic approach?
JG: There is a difference in rehabilitation. If you do a knee replacement, you can begin weight-bearing immediately but with biologics you have to have a waiting period to allow the new cartilage to mature. The patient goes through a much more controlled and protected rehabilitation.
Q: In what situations should physicians exercise caution when considering biologic knee replacements?
JG: The main thing is we shouldn't misinterpret this as a technique that can be used on anybody and therefore make knee replacements obsolete. There's still a relatively narrow set of criteria patients need in order for biologic help. A knee with severe osteoarthritis will not be helped with a biologic knee replacement. Active patients in the middle age range are the most appropriate.
Learn more about Dr. James Gladstone.
Read other coverage on minimally invasive procedures:
- Surgeon Analysis: Outpatient Lumbar Discectomy has Excellent Results, is Safe and Low Cost at ASCs
- Dr. Boyd Haynes: Q&A About Virginia's First Outpatient Total Knee Replacement
- Spine Education Labs Critical in Training for Cutting Edge Procedures
"There are a number of ways you can treat articular cartilage damage," says Dr. Gladstone. "The articular cartilage is like a smoothly paved road and inside of the road there's a pothole. When there's a pothole, the knee is exposed to extra stresses. If the patient feels more pressure, that’s when the patient starts experiencing pain. One option is microfracture. Microfracture puts small holes into the bone, accessing the bone marrow and blood supply. This creates a blood clot in the defect which recruitsi bone marrow stem cells, and growth factors."
Another option is cartilage cell transplantation where the knee’s healthy cartilage cells are harvested (sometimes grown in the lab) and then transplanted directly into the defect.
Dr. Gladstone is currently doing a study on the effectiveness of biologic knee replacement. He discusses some of the common concerns for physicians when deciding whether to perform biological knee replacements or the traditional total knee replacements.
Q: As a fairly new procedure, do you think the microfracture procedure will hold up over time?
Dr. James Gladstone: A number of more recent studies have shown that over time the fibrocartilge that forms may deteriorate. Another technique that is used is cartilage graft pasting. You harvest the cartilage and bones, mix the combination and place it into the defect. You're trying to activate cartilage cells and stem cells to repopulate the defect.
In most studies, the follow-up is not more than six years. What you would hope for ultimately would be a 20-year follow-up to show whether the cartilage integrity of the knee joint is upheld.
Q: Are there any advantages in biologic knee replacements as opposed to the traditional method of surgery?
JG: Biologic knee replacements are being done to people who have some pretty bad damage to their knee. These patients are missing the meniscus and portions of the cartilage. The encouraging thing is that studies show the biologic approach does seem to help. The biologic knee replacement can increase the time a patient has before they need a total knee replacement (TKR) and perhaps avoid a TKR altogether. Years ago, younger patients in pain had to wait for knee replacements, which have their own set of limitations.
Q: Is there a difference in the patient's recovery process with the biologic approach?
JG: There is a difference in rehabilitation. If you do a knee replacement, you can begin weight-bearing immediately but with biologics you have to have a waiting period to allow the new cartilage to mature. The patient goes through a much more controlled and protected rehabilitation.
Q: In what situations should physicians exercise caution when considering biologic knee replacements?
JG: The main thing is we shouldn't misinterpret this as a technique that can be used on anybody and therefore make knee replacements obsolete. There's still a relatively narrow set of criteria patients need in order for biologic help. A knee with severe osteoarthritis will not be helped with a biologic knee replacement. Active patients in the middle age range are the most appropriate.
Learn more about Dr. James Gladstone.
Read other coverage on minimally invasive procedures:
- Surgeon Analysis: Outpatient Lumbar Discectomy has Excellent Results, is Safe and Low Cost at ASCs
- Dr. Boyd Haynes: Q&A About Virginia's First Outpatient Total Knee Replacement
- Spine Education Labs Critical in Training for Cutting Edge Procedures