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Cartilage Cell Transplant

Home - Cartilage Cell Transplant

Cartilage Cell Transplantfor Eroded Knee Cartilages

There are many causes for painful worn cartilage in the knee joint: arthritis, arthrosis, traumas with bone or cartilage lesions or metabolic disorders like gout or hemochromatosis.

Osteoarthritis (worn cartilage) is the most common joint condition. The most common form of osteoarthritis is osteoarthritis of the knee. Osteoarthritis of the knee causes chronic pain and limits movement. The cartilage in the knee wears away over many years. Since the cartilage has no sensitive nerve endings (pain sensors), damage is only noticed when the defects already affect the bone beneath the cartilage.

A cartilage transplant, or cartilage cell or chondrocyte transplant, is a new surgical procedure: in which cartilage damage is repaired using cartilage cells from the patient’s own body.

The goals of a cartilage cell transplant of the knee:

  • Reduce pain due to knee osteoarthritis
  • Restoring the ability to bear weight and play sports
  • Improve flexibility
  • Restore the cartilage layer
  • Prevent a joint replacement
  • Preserve the joint and prevent osteoarthritis of the knee

Who is a knee cartilage transplant suitable for?

A cartilage transplant is not always a suitable treatment for osteoarthritis of the knee. If the cartilage defect in the knee is too severe, it is usually too late. In this case we would instead propose a joint-preserving partial knee replacement or a full knee replacement. There are several prerequisites for a successful cartilage transplant:

  • A stable knee with intact cruciate ligaments and collateral ligaments
  • A straight joint axis without deformity (severe knock-knees or bow legs)
  • No loose bodies (tissue which separated due to the cartilage defect in the knee)
  • Preserved menisci, at least for the most part
  • Cartilage only defective on one of the two joint surfaces

Typical indications for transplanting cartilage cells (chondrocytes) are local cartilage defects inside the knee.

What are the ideal conditions for transplanting cartilage cells into the knee?

  • Patient aged 15–55 years
  • Defect size up to 10 square centimetres with healthy cartilage remaining around the defect.
  • The knee should be stable, i.e. the ligaments intact.
  • Preferably no abnormal strain on the joint, e.g. due to obesity.

Although this method is typically only recommended for patients up to age 55, the biological age, not the calendar age of the patient is crucial. In some cases, cartilage transplants are even performed on patients over 65 years if the criteria are met. Recent MRI scans and X-rays help assess whether your specific case qualifies for this procedure. Germanten’sknee specialists can often only determine during the procedure whether a joint replacement or a cartilage transplant is the best treatment option.

If a cartilage cell transplant is not an option for you, there are other options like unicondylar knee replacement or a total knee replacement to treat osteoarthritis of the knee.

Procedure for harvesting cartilage for a cartilage transplant

After harvesting cartilage from a healthy section of the knee the cells are grown in a specialised cell culture lab.

Step 1: Harvesting a cartilage sample (biopsy specimen) from the knee

The surgeon will first harvest cartilage from the patient’s body using arthroscopy. The cartilage tissue, about the size of a grain of rice, is removed from a healthy section of the knee which does not bear much weight. The cartilage cells are isolated from this harvested tissue in a highly specialised cell culture lab and cultivated, i.e. grown, under sterile conditions.

This procedure takes about 30 minutes. The next day, approximately 120–150 ml blood is drawn from a vein in the patient’s arm. The laboratory uses this blood to obtain the serum (liquid part of the blood).

Step 2: Growing cells in the laboratory

The harvested rice-grain-sized cartilage specimen along with the patient’s blood sample are taken to the laboratory. The cartilage cells are isolated from the tissue sample and grown in the patient’s blood serum under sterile conditions. This procedure ensures that there are no foreign proteins or blood components in the patient’s body.

At the end of the production process, which typically takes 6-8 weeks, small spherical cell aggregates have formed which contain hundreds of thousands of augmentable cartilage cells. The cartilage cells are transported back to the clinic within hours inside special refrigerated containers to preserve the quality of the cells.

Who performs knee cartilage cell transplants?

At Germanten our knee specialist surgeon whom you consulted will take care of your treatment right from your first appointment to until after the cartilage cells have been transplanted. The same doctor is also responsible for your after-care. You will therefore have one contact person who will be assigned to you throughout your stay at Germanten.

What is the expected success rate of a cartilage cell transplant?

Cartilage cell transplants have been performed for about 25 years. Studies have shown the method significantly improves the cartilage surface in the joint. After the cartilage transplant the replacement cartilage cannot be distinguished from the original cartilage. The procedure can alleviate pain and restore mobility.

What happens prior to surgery?

Our surgeon will first perform detailed medical diagnostics to obtain a good overall picture. In addition to reviewing your medical history and a medical examination, this also includes X-rays whilst bearing weight and MRI scans (Magnetic resonance imaging) to assess the extent of the cartilage damage.

After determining that the patient is fit for surgery, the attending doctor will explain the procedure and possible complications of surgery. The patient will also meet with the anaesthetist, who will again review in detail whether the patient is healthy enough for anaesthesia. Once approved by the anaesthetist and the surgeon, the operation can typically be performed the next day.

What happens during the cartilage transplant surgery?

The cartilage cells are harvested arthroscopically. After they were grown at a specialised cell lab the doctor implants them in a minimally invasive operation. Only small skin incisions are needed to insert the necessary instruments in the knee.

The surgeon will first remove damaged cartilage tissue from the knee and then implant the cultured cartilage spheres (chondrospheres) into the prepared defective area. There they will immediately adhere to the bone and form connective tissue typical for cartilage to fill in the defect after a few weeks.

Once the cartilage cells establish contact with the prepared cartilage defect, their connective molecules (adhesion proteins) form a mechanically stable adhesion to the bone after roughly 10 minutes. The cartilage cells grow into the defect until it is completely filled in. The takes about 30–60 minutes unless other procedures on the cruciate ligaments or the meniscus are required.

To ensure a successful outcome of the cartilage transplant, it is important that problems which caused the cartilage damage (e.g. misalignments, cruciate ligament ruptures, meniscus damage, etc.), are identified and treated, which typically occurs at the same time as the cartilage transplant. In this way, the patient only needs to undergo one round of slightly time-consuming after-care and resting.

What type of anaesthetic is used for a cartilage cell transplant?

The cartilage cell transplant is typically performed under general anaesthesia. However, we can also perform it under spinal anaesthesia to reduce the risks of general anaesthesia. In this case the anaesthetist injects the anaesthetic into the vertebral canal of the lumbar spine. Here, the patient is conscious during surgery. Our anaesthetists are very experienced in both methods and choose the option best suited for you and your requirements during a pre-operation discussion.

Should I expect pain after the surgery?

Any procedure causes pain, but we always strive to minimise it. The anaesthetist will often use a nerve block before the surgery, numbing the respective knee for approximately 30 hours. This step alone manages the majority of the pain, and any residual discomfort can then be easily treated with oral medication. Our goal is for you to experience as little pain as possible.

What do I need to keep in mind after surgery?

You should elevate and ice your knee immediately following the procedure. The stitches will be removed about 7 to 12 days after the surgery. Once these are removed, you can also shower again.

You should rest your knee and avoid weight bearing for approx. 6 weeks to prevent complications. You will receive a special M4-orthese to prevent the knee from bending too much (depending where the cartilage defect was situated). We will also provide you with a medical sick leave and crutches for this period. Thrombosis prophylaxes are imperative during the time you are unable to put your full weight on the leg. Extensive physiotherapy is very important during this stage to prevent muscle loss and maintain the function of the knee.

You should plan your follow up 10 days after surgery. To maintain the function of the knee and to prevent muscle loss physiotherapy is very important.

Recommendations for after arthroscopy (1st procedure)

  • Inpatient treatment: 2 days
  • Optimal length of stay in Germanten Hospital: 7 days
  • Earliest return: 7 days after surgery
  • Recommended return flight: 10 days after surgery
  • Bathing permitted: 5 days after surgery
  • Recommended time off work: 2 weeks
  • Recommended removal of stitches: 5 days
  • Time before able to drive again: 2 weeks

Recommendations following cell implant (2ndprocedure)

  • Inpatient treatment: 3 days
  • Complete rest of the operated leg: 6 weeks
  • Then partial weight bearing of the operated leg: 6–8 weeks
  • Optimal length of stay on the premises: 10 days
  • Earliest return flight: 10 days after surgery
  • Recommended return flight: 14 days after surgery
  • Showering permitted: 7 days after surgery
  • Recommended time off work: 6 weeks
  • Recommended removal of stitches: 7–12 days
  • Time before able to drive again: 6–12 weeks

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