Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years.
Clinical outcomes
Customised
Focal cartilage lesion
Focal knee resurfacing
Metal implants
Personalized
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
01
06
2020
accepted:
14
09
2020
pubmed:
8
10
2020
medline:
27
8
2021
entrez:
7
10
2020
Statut:
ppublish
Résumé
Surgical treatment options for the management of focal chondral and osteochondral lesions in the knee include biological solutions and focal metal implants. A treatment gap exists for patients with lesions not suitable for arthroplasty or biologic repair or who have failed prior cartilage repair surgery. This study reports on the early clinical and functional outcomes in patients undergoing treatment with an individualised mini-metal implant for an isolated focal chondral defect in the knee. Open-label, multicentre, non-randomised, non-comparative retrospective observational analysis of prospectively collected clinical data in a consecutive series of 80 patients undergoing knee reconstruction with the Episealer® implant. Knee injury and Osteoarthritis Outcome Score (KOOS) and VAS scores, were recorded preoperatively and at 3 months, 1 year, and 2 years postoperatively. Seventy-five patients were evaluated at a minimum 24 months following implantation. Two patients had undergone revision (2.5%), 1 declined participation, and 2 had not completed the full data requirements, leaving 75 of the 80 with complete data for analysis. All 5 KOOS domain mean scores were significantly improved at 1 and 2 years (p < 0.001-0.002). Mean preoperative aggregated KOOS4 of 35 (95% CI 33.5-37.5) improved to 57 (95% CI 54.5-60.2) and 59 (95% CI 55.7-61.6) at 12 and 24 months respectively (p < 0.05). Mean VAS score improved from 63 (95% CI 56.0-68.1) preoperatively to 32 (95% CI 24.4-38.3) at 24 months. The improvement exceeded the minimal clinically important difference (MCID) and this improvement was maintained over time. Location of defect and history of previous cartilage repair did not significantly affect the outcome (p > 0.05). The study suggests that at 2 years, Episealer® implants are safe with a low failure rate of 2.5% and result in clinically significant improvement. Individualised mini-metal implants with appropriate accurate guides for implantation appear to have a place in the management of focal femoral chondral and osteochondral defects in the knee. IV.
Identifiants
pubmed: 33025052
doi: 10.1007/s00167-020-06289-7
pii: 10.1007/s00167-020-06289-7
pmc: PMC8384793
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2899-2910Informations de copyright
© 2020. The Author(s).
Références
Becher C, Kalbe C, Thermann H, Paessler HH, Laprell H, Kaiser T et al (2011) Minimum 5-year results of focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee. Arch Orthop Trauma Surg 131:1135–1143
pubmed: 21643800
doi: 10.1007/s00402-011-1323-4
Bollars P, Bosquet M, Vandekerckhove B, Hardeman F, Bellemans J (2012) Prosthetic inlay resurfacing for the treatment of focal, full thickness cartilage defects of the femoral condyle: a bridge between biologics and conventional arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:1753–1759
pubmed: 22076054
doi: 10.1007/s00167-011-1757-9
Cole BJ, Lee SJ (2003) Complex knee reconstruction: articular cartilage treatment options. Arthroscopy 19(Suppl 1):1–10
pubmed: 14673413
doi: 10.1016/j.arthro.2003.09.025
Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13:456–460
pubmed: 9276052
doi: 10.1016/S0749-8063(97)90124-9
Custers RJ, Dhert WJ, van Rijen MH, Verbout AJ, Creemers LB, Saris DB (2007) Articular damage caused by metal plugs in a rabbit model for treatment of localized cartilage defects. Osteoarthr Cartil 15:937–945
doi: 10.1016/j.joca.2007.02.007
Dansk Knaealloplastikregister (2013) Danish Knee Arthroplasty Register. Annual Report
Davies-Tuck ML, Wluka AE, Wang Y, Teichtahl AJ, Jones G, Ding C et al (2008) The natural history of cartilage defects in people with knee osteoarthritis. Osteoarthr Cartil 16:337–342
doi: 10.1016/j.joca.2007.07.005
Dhollander AAM, Almqvist KF, Moens K, Vandekerckhove PJ, Verdonk R, Verdonk P et al (2015) The use of a prosthetic inlay resurfacing as a salvage procedure for a failed cartilage repair. Knee Surg Sports Traumatol Arthrosc 23:2208–2212
pubmed: 24752537
doi: 10.1007/s00167-014-2999-0
Dugard MN, Kuiper JH, Parker J, Roberts S, Robinson E, Harrison P et al (2017) Development of a tool to predict outcome of autologous chondrocyte implantation. Cartilage 8:119–130
pubmed: 28345413
doi: 10.1177/1947603516650002
Fuchs A, Eberbach H, Izadpanah K, Bode G, Sudkamp NP, Feucht MJ (2018) Focal metallic inlay resurfacing prosthesis for the treatment of localized cartilage defects of the femoral condyles: a systematic review of clinical studies. Knee Surg Sports Traumatol Arthrosc 26:2722–2732
pubmed: 28918523
doi: 10.1007/s00167-017-4714-4
Goodfriend B, Essilfie AA, Jones IA, Thomas Vangsness Jr. C (2019) Fresh osteochondral grafting in the United States: the current status of tissue banking processing. Cell Tissue Bank 20:331–337
pubmed: 31214919
doi: 10.1007/s10561-019-09768-5
Graves S (2016) Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. AOA, Adelaide (ISSN 1445-3657)
Guettler JH, Demetropoulos CK, Yang KH, Jurist KA (2004) Osteochondral defects in the human knee: influence of defect size on cartilage rim stress and load redistribution to surrounding cartilage. Am J Sports Med 32:1451–1458
pubmed: 15310570
doi: 10.1177/0363546504263234
Hamilton TW, Pandit HG, Inabathula A, Ostlere SJ, Jenkins C, Mellon SJ et al (2017) Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss: a medium-term follow-up. Bone Jt J 99b:475–482
doi: 10.1302/0301-620X.99B4.BJJ-2016-1061.R1
Heir S, Nerhus TK, Rotterud JH, Loken S, Ekeland A, Engebretsen L et al (2010) Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. Am J Sports Med 38:231–237
pubmed: 20042546
doi: 10.1177/0363546509352157
Houck DA, Kraeutler MJ, Belk JW, Frank RM, McCarty EC, Bravman JT (2018) Do focal chondral defects of the knee increase the risk for progression to osteoarthritis? A review of the literature. Orthop J Sports Med 6:2325967118801931
pubmed: 30364400
pmcid: 6196633
Hunter DJ, Schofield D, Callander E (2014) The individual and socioeconomic impact of osteoarthritis. Nat Rev Rheumatol 10:437–441
pubmed: 24662640
doi: 10.1038/nrrheum.2014.44
Julin J, Jamsen E, Puolakka T, Konttinen YT, Moilanen T (2010) Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis. A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthop 81:413–419
pubmed: 20809740
pmcid: 2917562
doi: 10.3109/17453674.2010.501747
Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC et al (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Jt Surg Am 89:2105–2112
doi: 10.2106/00004623-200710000-00002
Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E et al (2004) Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Jt Surg Am 86:455–464
doi: 10.2106/00004623-200403000-00001
Kon E, Filardo G, Condello V, Collarile M, Di Martino A, Zorzi C et al (2011) Second-generation autologous chondrocyte implantation: results in patients older than 40 years. Am J Sports Med 39:1668–1675
pubmed: 21596901
doi: 10.1177/0363546511404675
Kuipers BM, Kollen BJ, Bots PC, Burger BJ, van Raay JJ, Tulp NJ et al (2010) Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 17:48–52
pubmed: 19716706
doi: 10.1016/j.knee.2009.07.005
Laursen JO, Lind M (2017) Treatment of full-thickness femoral cartilage lesions using condyle resurfacing prosthesis. Knee Surg Sports Traumatol Arthrosc 25:746–751
pubmed: 26220332
doi: 10.1007/s00167-015-3726-1
Laursen JO, Mogensen CB, Skjøt-Arkil H (2019) UniCAP offers a long term treatment for middle-aged patients, who are not revised within the first 9 years. Knee Surg Sports Traumatol Arthrosc 27:1693–1697
pubmed: 30756129
doi: 10.1007/s00167-019-05356-y
Li CS, Karlsson J, Winemaker M, Sancheti P, Bhandari M (2014) Orthopedic surgeons feel that there is a treatment gap in management of early OA: international survey. Knee Surg Sports Traumatol Arthrosc 22:363–378
pubmed: 23775341
doi: 10.1007/s00167-013-2529-5
Lyman S, Lee YY, McLawhorn AS, Islam W, MacLean CH (2018) What Are the Minimal and Substantial Improvements in the HOOS and KOOS and JR Versions After Total Joint Replacement? Clin Orthop Relat Res 476:2432–2441
pubmed: 30179951
pmcid: 6259893
doi: 10.1097/CORR.0000000000000456
Martinez-Carranza N, Berg HE, Hultenby K, Nurmi-Sandh H, Ryd L, Lagerstedt AS (2013) Focal knee resurfacing and effects of surgical precision on opposing cartilage. A pilot study on 12 sheep. Osteoarthr Cartil 21:739–745
doi: 10.1016/j.joca.2013.02.004
Meehan JP, Danielsen B, Kim SH, Jamali AA, White RH (2014) Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty. J Bone Jt Surg Am 96:529–535
doi: 10.2106/JBJS.M.00545
Messner K, Maletius W (1996) The long-term prognosis for severe damage to weight-bearing cartilage in the knee: a 14-year clinical and radiographic follow-up in 28 young athletes. Acta Orthop Scand 67:165–168
pubmed: 8623573
doi: 10.3109/17453679608994664
Mistry H, Connock M, Pink J, Shyangdan D, Clar C, Royle P et al (2017) Autologous chondrocyte implantation in the knee: systematic review and economic evaluation. Health Technol Assess 21:1–294
pubmed: 28619124
pmcid: 5494512
doi: 10.3310/hta21060
Mistry H, Metcalfe A, Smith N, Loveman E, Colquitt J, Royle P et al (2019) The cost-effectiveness of osteochondral allograft transplantation in the knee. Knee Surg Sports Traumatol Arthrosc 27:1739–1753
pubmed: 30721344
pmcid: 6541582
doi: 10.1007/s00167-019-05392-8
Nathwani D, McNicholas M, Hart A, Miles J, Bobic V (2017) Partial resurfacing of the knee with the BioPoly implant: interim report at 2 years. JB&JS Open Access 2(2):e0011
doi: 10.2106/JBJS.OA.16.00011
Niethammer TR, Muller PE, Safi E, Ficklscherer A, Rossbach BP, Jansson V et al (2014) Early resumption of physical activities leads to inferior clinical outcomes after matrix-based autologous chondrocyte implantation in the knee. Knee Surg Sports Traumatol Arthrosc 22:1345–1352
pubmed: 23839208
doi: 10.1007/s00167-013-2583-z
Odland AN, Callaghan JJ, Liu SS, Wells CW (2011) Wear and lysis is the problem in modular TKA in the young OA patient at 10 years. Clin Orthop Relat Res 469:41–47
pubmed: 20568028
doi: 10.1007/s11999-010-1429-y
Ogura T, Mosier BA, Bryant T, Minas T (2017) A 20-year follow-up after first-generation autologous chondrocyte implantation. Am J Sports Med 45:2751–2761
pubmed: 28745972
doi: 10.1177/0363546517716631
Pandit H, Gulati A, Jenkins C, Barker K, Price AJ, Dodd CA et al (2011) Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. Knee 18:168–171
pubmed: 20627734
doi: 10.1016/j.knee.2010.05.003
Pascual-Garrido C, Daley E, Verma NN, Cole BJ (2017) A comparison of the outcomes for cartilage defects of the knee treated with biologic resurfacing versus focal metallic implants. Arthroscopy 33:364–373
pubmed: 27663035
doi: 10.1016/j.arthro.2016.07.010
Pena E, Calvo B, Martinez MA, Doblare M (2007) Effect of the size and location of osteochondral defects in degenerative arthritis. A finite element simulation. Comput Biol Med 37:376–387
pubmed: 16796999
doi: 10.1016/j.compbiomed.2006.04.004
Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS (2003) Factors affecting the durability of primary total knee prostheses. J Bone Jt Surg Am 85:259–265
doi: 10.2106/00004623-200302000-00012
Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64
pubmed: 14613558
pmcid: 280702
doi: 10.1186/1477-7525-1-64
Roos EM, Toksvig-Larsen S (2003) Knee injury and Osteoarthritis Outcome Score (KOOS)—validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 1:17
pubmed: 12801417
pmcid: 161802
doi: 10.1186/1477-7525-1-17
Saris D, Price A, Widuchowski W, Bertrand-Marchand M, Caron J, Drogset JO et al (2014) Matrix-applied characterized autologous cultured chondrocytes versus microfracture: two-year follow-up of a prospective randomized trial. Am J Sports Med 42:1384–1394
pubmed: 24714783
doi: 10.1177/0363546514528093
Schell H, Zimpfer E, Schmidt-Bleek K, Jung T, Duda GN, Ryd L (2019) Therapy of osteochondral defects: chondrointegration of metal implants improves after hydroxyapatite coating. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-00019-05484-00165
doi: 10.1007/s00167-00019-05484-00165
pubmed: 30879107
Stalman A, Skoldenberg O, Martinez-Carranza N, Roberts D, Hogstrom M, Ryd L (2018) No implant migration and good subjective outcome of a novel customized femoral resurfacing metal implant for focal chondral lesions. Knee Surg Sports Traumatol Arthrosc 26:2196–2204
pubmed: 29167954
doi: 10.1007/s00167-017-4805-2
Stefanik JJ, Guermazi A, Roemer FW, Peat G, Niu J, Segal NA et al (2016) Changes in patellofemoral and tibiofemoral joint cartilage damage and bone marrow lesions over 7 years: the Multicenter Osteoarthritis Study. Osteoarthr Cartil 24:1160–1166
doi: 10.1016/j.joca.2016.01.981
Tirico LE, Demange MK, Santos LA, de Rezende MU, Helito CP, Gobbi RG et al (2016) Development of a fresh osteochondral allograft program outside North America. Cartilage 7:222–228
pubmed: 27375837
doi: 10.1177/1947603515618484