Not Ready for a Knee Replacement? Try a Cartilage Transplant

There are a variety of treatments for cartilage damage in the knee, ranging from pain and anti-inflammatory medications to complete knee replacement.  One of the most recent developments in treating knee problems is cartilage transplant surgery.

Cartilage transplant surgery is usually an option for patients who have damage that is localized rather than widespread.  It is an excellent choice for athletes and others who aren’t ready for total knee replacement.  While total knee replacement surgery is a great option for some patients, the decision of whether it or a cartilage transplant is right for you is up to you and your surgeon based on your knee issues and personal goals.

According to the American Academy of Orthopaedic Surgeons, cartilage transplants have “demonstrated excellent long-term outcomes, with consistent improvements…as well as reliable return to prior levels of activity.”

Who Can Get Cartilage Transplant Surgery?

Cartilage transplant surgery is not for everyone with knee arthritis or knee cartilage damage.  The procedure is usually recommended for patients who fit specific criteria, some of which include:

  • Under the age of 55 (most patients are between the ages of 18 and 40)
  • Healthy and physically active
  • A stable, properly-aligned knee
  • Knee pain for a relatively short duration (months rather than years)
  • Those who have pain even when resting
  • Localized, not widespread, cartilage damage (one or two areas of damaged cartilage rather than generalized osteoarthritis)

Types of Knee Cartilage Transplant Surgery

The majority of knee cartilage transplant surgeries fall into two categories: osteochondral autograph transplants or osteochondral allograft transplants.  There is also another less common surgery called autologous chondrocyte implantation.

Osteochondral Autograft Transplant

This minimally invasive surgery uses the patient’s own cartilage.  The surgeon will remove a small circle of healthy cartilage along with a sliver of underlying bone from an area of the joint that isn’t weight-bearing.  This “plug” is then surgically implanted into the area needing treatment.

This procedure is most effective for repairing relatively minor cartilage defects in the knee.  In some cases, more than one transplant will be performed.  This is referred to as mosaicplasty.  The entire procedure is done arthroscopically for minimal damage to surrounding tissues and a relatively quick healing time.

Osteochondral Allograft Transplant

This surgery uses cartilage from a lab or a cadaver.  It is generally performed when the area in need of repair is too large or too damaged for an autograft procedure to be effective.  Because it is more extensive, the surgery uses an open incision and requires additional healing time.

Autologous Chondrocyte Transplant

This is a more complex procedure using newly grown cartilage cells rather than existing cells.  Two surgeries will be needed rather than one, and the process is more complicated.

First, arthroscopic surgery will be performed to remove a small section of healthy cartilage from the knee joint.  The tissue is then cultured in a lab to allow new cells to grow.  Four to five weeks later, a second, open-incision surgery will be performed to transplant the new cells into the damaged joint.

Autologous chondrocyte transplants are generally reserved for patients who have multiple areas of cartilage injury or damage to a large area of up to several centimeters.

Advantages of Cartilage Transplants

There are some distinct advantages to cartilage replacement in the knee, particularly for younger, physically active patients:

  • Quicker recovery time than knee replacement
  • Less-invasive procedures with less chance of infection and scarring
  • Immediate, long-term pain reduction
  • Improved movement and ability to return to physical activities
  • Natural regrowth of cartilage
  • Maintains the stability of the knee joint

Challenges of Replacing Worn or Damaged Cartilage

Cartilage replacement isn’t an easy task.  While cartilage cells can be cloned in a laboratory, they don’t always respond and grow well when transplanted into the body.  Placing them into a particular area like the knee joint and getting them to function can be problematic.

In a successful cartilage transplant, the knee joint will accept transplanted cartilage and allow it to grow and adhere properly to the surfaces of the knee bones.  After the cartilage has adhered successfully, it will need to be strong enough to withstand the tremendous pressure the body places on the joint.  It will also need to be smooth enough to glide and permit normal movement.  A successful procedure can bring patients years of relief, stability, and pain-free movement.

What to Expect After Cartilage Transplant Surgery

Cartilage replacement is often a minimally invasive procedure, with patients returning home the same day or the day after surgery.  You’ll receive post-surgical care instructions from your surgeon.  Patients should keep the knee elevated, take any prescribed pain relievers and anti-inflammatories, and control any swelling with periodic applications of ice.  The incisions will be covered for the first few days.

A few days after surgery, you’ll have a follow-up visit with your surgeon.  He or she will evaluate your knee and determine post-operative care for the coming weeks.  For the first two weeks, minimal use of the knee is recommended.  Most patients will need to use crutches for six weeks.  During this time, no weight-bearing is possible.  This allows the cartilage to strengthen and become smooth enough for proper movement.

Physical therapy is also a crucial element of recovery.  It will promote healing, keep the joint flexible, and encourage blood flow to the area and nourishment of the transplanted cartilage.  After six weeks, physical therapy will include a gradual increase in weight-bearing exercises.  At the twelve-week mark, most patients can stand and walk unaided.

Exercise & Activities After Cartilage Transplant Surgery

At the three-month mark after surgery, your surgeon or physical therapist will recommend low-impact activities such as swimming, walking, or cycling.  At six months, you may be able to begin jogging.  From nine months to a year after surgery, most patients can return to normal activities such as skiing, football, and other contact sports.

At Arkansas Surgical Hospital, our orthopedic surgeons are experienced with this type of complex surgery.  They can work with patients to determine whether cartilage transplant surgery is a viable option and what kind of transplant will provide the best possible knee relief.  Contact Arkansas Surgical Hospital today for help setting up an appointment.

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