Patient specific mini-metal implants. The future of cartilage repair for the right patient?
ESSKA Academy. Holz J. 11/08/19; 286387
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Patient specific mini-metal implants. The future of cartilage repair for the right patient?

EKA Free Papers

Topic: HTO

Holz J.1, Spalding T.2, Verdonk P.3, Lind M.4, Emans P.5, Eriksson K.6, Konradsen L.7, Hogstrom M.8, Kösters C.9
1OrthoCentrum Hamburg, Hamburg, Germany, 2University Hospitals Coventry and Warwickshire NHS Trust, Warwick, United Kingdom, 3Antwerp Orthopedic Center, Monica Hospitals, Antwerp, Belgium, 4Aarhus University Hospital, Devision of Sportmedicine, Dept. Orthopedics, Aarhus, Denmark, 5Maastricht UMC, Dept. of Orthopedics, Masstricht, Netherlands, 6Stockholm South Hospital, Karolinska Institut, Dept. of Orthopedic Surgery, Stockholm, Sweden, 7Gildhoff Privathospital, Brondby, Denmark, 8Sports Medicine Umea, Umea, Sweden, 9Maria-Josef Krankenhaus, Orthopädische Klinik (Greven), Greven, Germany

Introduction: Patients in the 'gap age' 35-60 years old, with focal cartilage lesions are often considered too young for an arthroplasty and too old for biologic repair. Many may have already had failed prior surgery
Objectives: We report prospective detailed results of patients undergoing treatment for chondral defects in the knee using a patient-specific individualized mini-metal implant, based on three-dimensional MRI planning.
Aims: Proofing the effectiveness of the implant in the treatment of severe cartilage defects
Methods: 100 patients (45 men and 55 women) with focal cartilage lesions ICRS grade 3 or 4 undergoing articular cartilage repair with an individualized metallic implant were prospectively analysed. Inclusion criteria were isolated chondral or osteochondral defects and a history of failed conservative treatment.
Detailed specific MRI data was used to manufacture patient specific implants and guide instruments by a CAD/CAM process, to fit the unique anatomy of each individual knee. Implants were uncemented and made of chrome-cobalt, double coated with hydroxyapatite on top of Titanium. Demographic, operative and clinical scores (VAS and KOOS) were collected preop and at 3 mon, 1 and 2 years postoperatively.
Results: Mean age of the 100 patients was 49 years (range 27-72 and only 5 patients below age 35), with mean BMI 28 (range 19-41). 52% had failed previous cartilage surgery. Location of repair was 82 on medial condyle, 6 lateral condyle and 12 on trochlea. 12-month scores were available in 82 and 24-month scores in 55 (93% resp. 88%) of patients due.
Mean KOOS scores for all 5 domains were significantly improved at 1 and 2 years (p< 0.05). Mean preoperative aggregated KOOS was 38 which improved to 61 at 12 months and 63 at 24 months (n=54), (p< 0.05). Mean VAS score improved from 63 preoperatively to 36 at 12 months and 34 at 24 months.
1 patient (1.5%) underwent revision to arthroplasty at 15 months due to progression of arthritis.
Conclusion: The study shows excellent early clinical results in the treatment of focal symptomatic cartilage lesions on the femoral condyles or trochlea with a second-generation patient specific metal implant and instruments. Adherence to strict indications has allowed for high patient reported scores and low early revision rate. For the right patient, especially those facing revision articular cartilage repair this surgery appears to be a good option.
Keywords: patient specific implant, focal cartilage lesions.
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