Cartilage Repair versus Knee Replacement

When 65-year-old Mridula Apte came to see Dr Muthukumar at Parvathy Hospital, she was in extreme pain. She was unable to bend her left knee, or move around the house in spite of taking a painkiller every three hours. She had tried alternative therapies like acupuncture and nutritional supplements but they had little effect on her pain. Then, she considered regrowing her cartilage but decided against it when a quick search on the internet showed that for a chronic osteoarthritic knee, total knee replacement is the only treatment option.

Later, she came to Parvathy hospital to seek opinion of Dr. Muthukumar. A thorough investigation at Parvathy revealed that there was widespread damage in the cartilage of her left knee and the doctors performed a total knee replacement surgery on her. 3 days later, Mrs Apte was walking once again. Fast forward to 8 weeks, and Mrs Apte was fit enough to go for long walks at the Marina beach.

What is cartilage damage?

Cartilage is a connective tissue and it is found in many parts of the body. It is tough and rubbery but gets damaged easily. Some body parts are entirely made up of cartilage, like our ears.
A healthy knee has the ends of thigh and shin bones covered with smooth, white cartilage tissue that covers the ends of bones, where they fuse to form joints. The cover of cartilage reduces friction and acts as a cushion between joints and helps support our weight when we run, bend and stretch. Cartilage does not have an independent blood supply. Hence, it is unable to treat its damage on its own.

What are the symptoms of cartilage damage?
Osteoarthritis mostly damages the joint cartilage in the knee, but the elbow, wrist, ankle, shoulder and hip joint can also get affected. When the rubbery tissue covering of cartilage wears off the bones do not glide against each other smoothly, but begin to rub against one-another. This causes severe pain, inflammation and immobility.

Symptoms:
  • Joint pain
  • Swelling of the joints
  • Stiffness of the joints
  • Clicking sensation in the joints
  • Joint locking
  • Joint catching

As the cartilage damage progresses, the affected knee joint will not move so freely which will cause pain during daily activities like walking, bending, stretching and playing.

Cartilage repair versus Knee replacement

When you consult a knee surgeon for knee pain , the doctor investigates the extent of cartilage damage in your joint through an MRI (Magnetic Resonance Imaging).

An MRI will show the detailed imaging of your knee. If your knee cartilage has localised damage, your doctor will recommend the first-line of treatment, like physiotherapy and weight loss If these therapies do not work and your knee continues to hurt so much that it becomes difficult for you to get through the day, your knee surgeon may choose one of the following surgical options to treat damaged cartilage.

Debridement – In this process, the surgeon uses small arthroscopic instruments to remove loose edges of the cartilage, rubbing other parts of the body.
Mosaicplasty – The surgeon takes healthy undamaged cartilage from one area and moves it to the damaged site.

Autologous chondrocyte implantation – First performed in 1987 in Sweden, Autologous Chondrocyte implantation, also known as knee stem cell repair removes a small piece of cartilage to culture more cartilage cells. About 1 to 3 months later the new cartilage cells are implanted into the diseased knee, where they grow into healthy tissue.

Who should go for knee stem cell repair?
Of late, there is significant media attention on knee stem cell repair, as a non-surgical way to become pain-free. The fact is that this therapy is not for everyone. It is not for knees affected by osteoarthritis, a condition that causes natural cartilage deterioration due to ageing.

It shows the best outcome in young patients with knee cartilage damage or deterioration caused by:

  • Sports injuries
  • Repetitive use of the joint
  • Osteochondritis dessicans (OCD)
Knee Replacement

As osteoarthritis progresses, the cartilage covering the ends of the bones will gradually roughen and become thin and the bone underneath thickens. There may be bony spur like growths. The inner layer of the joint capsule will make extra fluid which will cause the joint to swell and become painful.

Initially, your knee surgeon will prescribe conventional treatment options, including pain relievers, physiotherapy and weight loss for knees affected by osteoarthritis. When these therapies fail, then your knee surgeon will recommend knee surgery as the last resort.

Largely, knee replacement patients are between the ages of 60 and 80, but in some cases, younger patients with traumatic knee injuries may also require a total knee replacement. The oldest patient at Parvathy so far was 102-years old.

In a knee replacement operation, the old knee and the hard cartilage are removed and replaced with metal and plastic parts. The plastic acts like hard cartilage, which helps the joint to move freely. The artificial joint has interlocking parts which allows your knee to bend and makes it more stable.

Cartilage repair may look a shortcut to knee replacement but it works only for younger patients who have healthy knees. It is not meant for older patients suffering from osteoarthritis. Be assured, your knee surgeon will exhaust conventional pain relief options before he advises the knee replacement surgery.

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