Complications common after knee cartilage implant

NEW YORK (Reuters Health) - More than one out of every six patients who have an implant of their own tissue to treat a knee cartilage defect will require repeat surgery, according to a new report on 309 patients treated with the procedure.

The surgery, known as autologous chondrocyte implantation (ACI), involves an initial surgery to remove cartilage cells from the knee, which are grown in the lab and then, in a second procedure, are used to fill in the gap in the patient’s cartilage.

While the surgery is now a “well-established therapy,” Dr. Philipp Niemeyer of Freiburg University Hospital in Freiburg im Breisgau, Germany, and colleagues point out, there is little information on complications that occur after the surgery or how such complications should be treated.

To investigate, the researchers looked at 309 patients who had collectively undergone 349 ACI surgeries at their hospital between 2001 and 2006. Three different ACI techniques were used: the periosteal patch (14.9 percent of surgeries), in which the membrane covering the bone of the adjacent tibia is used to cover the cartilage graft; the Chondro-Gide patch, a membrane derived from pig cells (61.6 percent); or the matrix-associated method, in which the cells are grown within a 3-dimensional scaffold and then implanted into the bone (23.5 percent).

During an average of 4.5 years of follow-up, 52 of the patients, or 16.8 percent, needed repeat surgery due to continuing problems, such as pain or loss of function.

The complications could be classified into four basic categories: overgrowth, or hypertrophy, of the cartilage graft, in 30.8 percent of cases; failure of the graft to fuse adequately with healthy cartilage (23.1 percent); an insufficient amount of cartilage regeneration (17.3 percent); or a tearing away of the intact cartilage near the repair, also in 17.3 percent of patients.

Hypertrophy was most common in patients treated with the periosteal patch technique, and least likely to occur in patients treated with Chondro-Gide.

Hypertrophy is best treated by using devices called bipolar electrocounters, the researchers say, because using a conventional instrument to shave down the tissue can be harmful. Smaller defects can be treated by using drilling or making tiny fractures in the bone to stimulate growth, or with repeat ACI for larger defects.

“No consistent concept can be found concerning the performed therapies for the detected complications,” they add. “Further studies need to be conducted to establish concepts and therapeutic strategies to address these complications.”

Following up on ACI complications is extremely difficult, Niemeyer and colleagues say, because MRI scans only revealed a specific diagnosis in a fraction of the patients. If patients continue to have symptoms after ACI, they add, the decision to perform a repeat arthroscopy “should be made generously.”

SOURCE: American Journal of Sports Medicine, November 14, 2008.

Source

--------------------------------------------------------------------------------------------
Related Posts:


By Michael Kahn LONDON (Reuters) - Doctors may one day be able to use stem cells taken from umbilical cord blood to build new heart valves for children born with heart defects, German scientists said on Monday. These valves could grow as a child develops, doing away with any need for repeated operations to replace outgrown artificial

Full Post: Umbilical cord blood may help build heart valves
--------------------------------------------------------------------------------------------

By Michael Kahn LONDON (Reuters) - A Colombian woman has received the world’s first tailor-made trachea transplant, grown by seeding a donor organ with her own stem cells to prevent her body rejecting it, an international research team reported on Wednesday. The success of the operation, performed in June using tissue generated from the woman’s own bone

Full Post: Woman gets first trachea transplant without drugs
--------------------------------------------------------------------------------------------

NEW YORK (Reuters Health) - An elderly person who has fractured their femur - the large thigh bone that connects the leg to the hip - may want to have surgery sooner rather than later, according to a study linking longer times to surgery to a somewhat increased risk of post-surgery complications. Dr. Rudiger Smektala from

Full Post: Delayed surgery may affect fracture recovery
--------------------------------------------------------------------------------------------

NEW YORK (Reuters Health) - Surgery to remove the esophagus is not being used as often as it should be for some cases of early-stage cancer of the esophagus. That’s the conclusion of Dr. E. Carter Paulson and colleagues, from the Hospital of the University of Pennsylvania in Philadelphia, who assessed the treatment of 2,386 patients

Full Post: Surgery underused for esophagus cancer: study
--------------------------------------------------------------------------------------------

By Will Boggs, MD NEW YORK (Reuters Health) - For smokers scheduled to undergo an operation, a smoking cessation program that starts shortly before surgery lowers the rate of postop complications, a Scandinavian study shows. The time around a surgical procedure “is a highly effective period for introducing a smoking cessation intervention, and the patients have a

Full Post: Quit-smoking program cuts postop complications

Site Navigation

Most Read

Search

Contact

  • kinwrite.com@gmail.com