Knee Cartilage Replacement: Options and Longevity Insights

Regarding knee cartilage replacement?

Hello Doctor, ten years ago, I suffered a car accident that resulted in a comminuted fracture of my left knee joint, along with a torn meniscus and a ruptured anterior cruciate ligament (ACL).
This has led to subchondral bone depression on the medial side of the joint, and possibly due to the medical understanding at that time, some cartilage tissue was removed.
Consequently, I have been experiencing ongoing post-traumatic osteoarthritis and pain.
During this period, I have taken non-steroidal anti-inflammatory drugs (NSAIDs) and have undergone arthroscopic repair surgery approximately every three years.
In the most recent surgery, it seems that the joint space was too small, which may have resulted in laxity of the ligament.
Recently, I also received injections of hyaluronic acid for joint lubrication.
Some doctors have suggested a total knee arthroplasty.
However, first, the lifespan of prosthetic joints covered by health insurance tends to be shorter, which would inevitably require multiple replacement surgeries during my lifetime.
Second, I have learned that the lifespan of artificial joints is not well-documented due to the relatively short time they have been in use, making it difficult to assess their efficacy.
Third, due to multiple surgeries, my body has developed additional complications, necessitating consultations with other medical specialties, including minor regional surgical procedures.
Therefore, I would like to inquire: [1] From some medical literature, I have seen references to artificial tissue-cultured cartilage replacement.
I would like to know which hospitals in the country are currently engaged in this type of research and what the progress is.
[2] Based on current cases, what is the approximate lifespan of a partial knee prosthesis? After reaching the end of its lifespan, what are the risks associated with subsequent replacement surgeries? Additionally, what is the cumulative harm to the body from the debris generated? I would appreciate your advice.

Yu, 30~39 year old female. Ask Date: 2006/02/02

Dr. Shi Guozheng reply Orthopedics

Currently, artificial tissue-cultured cartilage replacement is mostly in the animal experimental stage, with very few applications in humans.
However, some medical centers are performing autologous cartilage transplantation.
If you are referring to a unicompartmental knee arthroplasty when you mention a partial artificial knee joint, its clinical use can last approximately ten to fifteen years.
According to reports from abroad, subsequent revisions are still feasible, with risks comparable to the initial surgery.
The debris generated poses minimal harm to the human body; some may cause pigmentation, and there may be localized lymphadenopathy, but the likelihood of these occurrences is very low.

Reply Date: 2006/02/02

More Info

Knee cartilage replacement and management of knee osteoarthritis are complex topics, especially for individuals with a history of significant knee injuries and multiple surgeries. Your situation, involving a history of traumatic knee injuries, osteoarthritis, and the consideration of knee replacement surgery, raises several important questions regarding treatment options and their longevity.

1. Understanding Cartilage Replacement Options
Cartilage replacement techniques have evolved over the years, and there are several options available, including:
- Microfracture: This technique involves creating small holes in the bone beneath the damaged cartilage to stimulate the growth of new cartilage. However, the new cartilage formed is typically fibrocartilage, which is not as durable as the original hyaline cartilage.

- Osteochondral Autograft Transplantation (OAT): In this procedure, healthy cartilage and bone are taken from a non-weight-bearing area of the knee and transplanted to the damaged area. This method can provide a more durable solution but is limited by the availability of healthy cartilage.

- Allograft Transplantation: This involves using donor cartilage from cadavers. It can be a good option for larger defects but carries risks of rejection and disease transmission.

- Stem Cell Therapy: Emerging research is exploring the use of stem cells to regenerate cartilage. This is still largely experimental, and results can vary.

- Tissue Engineering: This is an area of active research where scientists are working on growing cartilage in the lab using a patient's cells. While promising, it is not widely available yet.

In terms of hospitals in your area that may be conducting research on cartilage tissue engineering, it would be best to consult with major orthopedic centers or universities that have a focus on sports medicine and regenerative medicine.

2. Longevity of Partial Knee Replacements
Regarding the longevity of partial knee replacements, studies suggest that they can last anywhere from 10 to 20 years, depending on various factors such as the patient's age, activity level, weight, and overall health. The longevity of a knee implant can also be influenced by the surgical technique and the type of implant used.

After reaching the end of an implant's lifespan, the risks associated with revision surgery include:
- Infection: This is a significant risk with any surgical procedure, especially in revision surgeries where the tissue may be more compromised.

- Bone Loss: Revision surgeries may require additional bone removal, which can complicate future surgeries.

- Implant Failure: There is a risk that the new implant may not function as well as the original, leading to further complications.

- Accumulation of Wear Particles: Over time, wear and tear on the implant can produce microscopic particles that may lead to inflammation and further joint damage.

Recommendations
Given your history of multiple surgeries and the potential for additional complications, it is crucial to have a thorough discussion with your orthopedic surgeon about the best course of action. They can provide personalized recommendations based on your specific condition, including:
- Conservative Management: If your symptoms are manageable, continuing with physical therapy, lifestyle modifications, and pain management strategies may be advisable.

- Surgical Options: If conservative measures fail, discussing the potential benefits and risks of partial or total knee replacement is essential. Your surgeon can help you weigh the pros and cons based on your unique circumstances.

- Second Opinion: Given the complexity of your case, seeking a second opinion from a specialist in knee reconstruction or a center that focuses on joint preservation techniques may provide additional insights.

In conclusion, while knee cartilage replacement and joint replacement surgeries can offer significant relief and improved function, they come with their own set of risks and considerations. Staying informed and actively participating in your treatment decisions will be key to achieving the best possible outcome.

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