Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 9/2017

01-09-2017 | Knee Arthroplasty

Focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee: 12-year follow-up of two cases and review of the literature

Authors: C. Becher, E. B. Cantiller

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2017

Login to get access

Abstract

Introduction

The rationale of focal articular prosthetic resurfacing used as a primary arthroplasty procedure in the treatment of articular cartilage defects is still under debate. Conflicting reports raise concern about high rates of re-operations and continued development of osteoarthritis, while others have reported good outcomes. The goal of this paper is to present the long-term results of two patients with a 12-year follow-up and to report the results of a literature review.

Materials and methods

Two patients (male, 70 years; female 63 years) with a follow-up of 12 years were reviewed. Patients were evaluated with standard radiographs to assess the progression of osteoarthritis (OA), a clinical examination including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity scale. The literature review was performed using the search terms HemiCAP, focal, femoral, condyle, inlay, and resurfacing to identify articles published in the English language up until September 25, 2016.

Results

The clinical and radiographic follow-ups of the patients were 11.9 and 11.8 years, respectively. Both patients were satisfied with their outcome and would have the operation again. Comparing the first postoperative to 12-year follow-up X-rays, the radiographic results demonstrated no signs of periprosthetic loosening, preservation of joint space, and no change in the osteoarthritic stage. KOOS Scores were 86 and 83 for pain, 89 and 93 for symptoms, 88 and 100 for activities of daily living (ADL), 75 and 65 for sports and recreation, and 75 and 81 for quality of life (QOL). The Tegner activity level was 5 and 4. The literature review comprised 6 studies with 169 focal articular prosthetic resurfacing procedures in 169 patients (84 male, 85 female) with a mean age at implantation ranging from 44.7 to 53.7 years and a follow-up range of 20 months to 7 years. Five studies were classified as level 4 and one as level 3. Clinical and radiographic results showed mainly good to excellent outcomes but were different among the studies depending on the indication. Re-operation rates ranged from 0 to 23% depending on the length of follow-up.

Conclusions

The results suggest that focal articular prosthetic resurfacing is an effective and safe treatment option in selected cases.
Literature
1.
(2015) Australian Orthopaedic Association National Joint Replacement Registry (ed)
2.
Becher C, Huber R, Thermann H, Tibesku CO, von Skrbensky G (2009) Tibiofemoral contact mechanics with a femoral resurfacing prosthesis and a non-functional meniscus. Clin Biomech (Bristol, Avon) 24(8):648–654CrossRef
3.
Becher C, Kalbe C, Thermann H 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(8):1135–1143CrossRefPubMed
4.
Bekkers JE, de Windt TS, Raijmakers NJ, Dhert WJ, Saris DB (2009) Validation of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for the treatment of focal cartilage lesions. Osteoarthr Cartil 17(11):1434–1439CrossRefPubMed
5.
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(9):1753–1759CrossRefPubMed
6.
Briggs DT, Sadr KN, Pulido PA, Bugbee WD (2015) The use of osteochondral allograft transplantation for primary treatment of cartilage lesions in the knee. Cartilage 6(4):203–207CrossRefPubMedPubMedCentral
7.
Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10(1):2–11CrossRefPubMed
8.
Dhollander AA, Almqvist KF, Moens K 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(8):2208–2212CrossRefPubMed
9.
Goebel L, Kohn D, Madry H (2016) Biological reconstruction of the osteochondral unit after failed focal resurfacing of a chondral defect in the knee. Am J Sports Med 44(11):2911–2916CrossRefPubMed
10.
Goyal D, Keyhani S, Goyal A, Lee EH, Hui JH, Vaziri AS (2014) Evidence-based status of osteochondral cylinder transfer techniques: a systematic review of level I and II studies. Arthroscopy 30(4):497–505CrossRefPubMed
11.
Hambly K, Griva K (2008) IKDC or KOOS? Which measures symptoms and disabilities most important to postoperative articular cartilage repair patients? Am J Sports Med 36(9):1695–1704CrossRefPubMed
12.
Hangody L, Fules P (2003) Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Jt Surg Am 85-A(Suppl 2):25–32CrossRef
13.
Hobbs H, Ketse-Matiwani N, Van der Merwe W, Posthumus M (2013) Focal full thickness articular cartilage lesions treated with an articular resurfacing prosthesis in the middle-aged. S Afr Orthop J 12(4):6
14.
Jungmann PM, Salzmann GM, Schmal H, Pestka JM, Sudkamp NP, Niemeyer P (2012) Autologous chondrocyte implantation for treatment of cartilage defects of the knee: what predicts the need for reintervention? Am J Sports Med 40(1):58–67CrossRefPubMed
15.
16.
Kirker-Head CA, Van Sickle DC, Ek SW, McCool JC (2006) Safety of, and biological and functional response to, a novel metallic implant for the management of focal full-thickness cartilage defects: preliminary assessment in an animal model out to 1 year. J Orthop Res 24(5):1095–1108CrossRefPubMed
17.
Knutsen G, Drogset JO, Engebretsen L et al (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Jt Surg Am 89(10):2105–2112
18.
Kon E, Verdonk P, Condello V et al (2009) Matrix-assisted autologous chondrocyte transplantation for the repair of cartilage defects of the knee: systematic clinical data review and study quality analysis. Am J Sports Med 37(Suppl 1):156S–166SCrossRefPubMed
19.
Kreuz PC, Erggelet C, Steinwachs MR et al (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22(11):1180–1186CrossRefPubMed
20.
Laursen JO, Lind M (2015) Treatment of full-thickness femoral cartilage lesions using condyle resurfacing prosthesis. Knee Surg Sports Traumatol Arthrosc 25(3):746–751CrossRefPubMed
21.
Maier MW, Kuhs F, Streit MR et al (2015) Unicompartmental knee arthroplasty in patients with full versus partial thickness cartilage loss (PTCL): equal in clinical outcome but with higher reoperation rate for patients with PTCL. Arch Orthop Trauma Surg 135(8):1169–1175CrossRefPubMed
22.
Manda K, Ryd L, Eriksson A (2011) Finite element simulations of a focal knee resurfacing implant applied to localized cartilage defects in a sheep model. J Biomech 44(5):794–801CrossRefPubMed
23.
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(5):739–745CrossRefPubMed
24.
Martinez-Carranza N, Ryd L, Hultenby K et al (2016) Treatment of full thickness focal cartilage lesions with a metallic resurfacing implant in a sheep animal model, 1 year evaluation. Osteoarthr Cartil 24(3):484–493CrossRefPubMed
25.
Mobasheri A, Kalamegam G, Musumeci G, Batt ME (2014) Chondrocyte and mesenchymal stem cell-based therapies for cartilage repair in osteoarthritis and related orthopaedic conditions. Maturitas 78(3):188–198CrossRefPubMed
26.
Niemeyer P, Feucht MJ, Fritz J, Albrecht D, Spahn G, Angele P (2016) Cartilage repair surgery for full-thickness defects of the knee in Germany: indications and epidemiological data from the German Cartilage Registry (KnorpelRegister DGOU). Arch Orthop Trauma Surg 136(7):891–897CrossRefPubMed
27.
Oussedik S, Tsitskaris K, Parker D (2015) Treatment of articular cartilage lesions of the knee by microfracture or autologous chondrocyte implantation: a systematic review. Arthroscopy 31(4):732–744CrossRefPubMed
28.
Pascual-Garrido C, Daley E, Verma NN, Cole BJ (2016) A Comparison of the outcomes for cartilage defects of the knee treated with biologic resurfacing versus focal metallic implants. Arthroscopy 33(2):364–373CrossRefPubMed
29.
Peterson L, Minas T, Brittberg M, Lindahl A (2003) Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am 85-A(Suppl 2):17–24CrossRef
30.
Petri M, Ettinger M, von Falck C, Hawi N, Jagodzinski M, Haasper C (2013) Reconstruction of osteochondral defects by combined bone grafting and a bilayer collagen membrane as a sandwich technique. Orthop Rev (Pavia) 5(4):e36CrossRef
31.
Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96CrossRefPubMed
32.
Saris D, Price A, Widuchowski W 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(6):1384–1394CrossRefPubMed
33.
Saris DB, Vanlauwe J, Victor J et al (2009) Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med 37(Suppl 1):10S–19SCrossRefPubMed
34.
Spahn G, Fritz J, Albrecht D, Hofmann GO, Niemeyer P (2016) Characteristics and associated factors of Klee cartilage lesions: preliminary baseline-data of more than 1000 patients from the German cartilage registry (KnorpelRegister DGOU). Arch Orthop Trauma Surg 136(6):805–810CrossRefPubMed
35.
Steadman JR, Rodkey WG, Rodrigo JJ (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 391 Suppl:S362–S369CrossRef
36.
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
37.
Wood JJ, Malek MA, Frassica FJ et al (2006) Autologous cultured chondrocytes: adverse events reported to the United States Food and Drug Administration. J Bone Jt Surg Am 88(3):503–507
38.
Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Joint Surg Am 85-A(1):1–3CrossRefPubMed
Metadata
Title
Focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee: 12-year follow-up of two cases and review of the literature
Authors
C. Becher
E. B. Cantiller
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 9/2017
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-017-2717-8

Other articles of this Issue 9/2017

Archives of Orthopaedic and Trauma Surgery 9/2017 Go to the issue

Trauma Surgery

Reduction and ring fixation of instable C1 fractures with monoaxial pedicle screws

Trauma Surgery

Comment on the article: Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized controlled trial

Trauma Surgery

Management of proximal humeral fractures by the Ilizarov external fixator

Trauma Surgery

Outcomes of coronoid-first repair in terrible triad injuries of the elbow

Orthopaedic Surgery

Comminuted olecranon fractures: biomechanical testing of locked versus minifragment non-locked plate fixation

Arthroscopy and Sports Medicine

High non-anatomic tunnel position rates in ACL reconstruction failure using both transtibial and anteromedial tunnel drilling techniques