Clinical Orthopaedics and Related Research®

, Volume 468, Issue 1, pp 147–157 | Cite as

Autologous Chondrocyte Implantation for Joint Preservation in Patients with Early Osteoarthritis

  • Tom Minas
  • Andreas H. Gomoll
  • Shahram Solhpour
  • Ralf Rosenberger
  • Christian Probst
  • Tim Bryant
Symposium: Papers Presented at the Annual Meetings of the Knee Society

Abstract

Young patients with early osteoarthritis wishing to remain functionally active have limited treatment options. Existing studies examining the use of autologous chondrocyte implantation (ACI) have included patients with early degenerative changes; however, none specifically investigated the outcome of ACI with this challenging problem. We prospectively followed 153 patients (155 knees) for up to 11 years after treatment with ACI for early-stage osteoarthritis. Patient pain and function was assessed using WOMAC, modified Cincinnati, SF-36, Knee Society score, and a satisfaction questionnaire. Mean patient age was 38.3 years. On average, 2.1 defects were treated per knee; the mean defect size was 4.9 cm2 and total area per knee was 10.4 cm2. Eight percent of joints were considered treatment failures that went on to arthroplasty and the remaining patients experienced 50% to 75% improvement in WOMAC subscales. Our data suggest that ACI in patients with early osteoarthritis results in clinically relevant reductions in pain and improvement in function. At 5 years postoperatively, 92% of patients were functioning well and were able to delay the need for joint replacement. Given the limited number of treatment options for this subset of patients, autologous chondrocyte implantation may offer improved quality of life for young osteoarthritic patients.

Level of Evidence: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Notes

Acknowledgments

We thank Jae Hee Kang, ScD, Harvard School of Public Health, for her assistance with the statistical analyses.

References

  1. 1.
    Ahlback S. Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Diagn (Stockh). 1968;Suppl 277:7–72.Google Scholar
  2. 2.
    Amendola A, Rorabeck CH, Bourne RB, Apyan PM. Total knee arthroplasty following high tibial osteotomy for osteoarthritis. J Arthroplasty. 1989;4 Suppl:S11–S17.CrossRefPubMedGoogle Scholar
  3. 3.
    Angst F, Aeschlimann A, Michel BA, Stucki G. Minimal clinically important rehabilitation effects in patients with osteoarthritis of the lower extremities. J Rheumatol. 2002;29:131–138.PubMedGoogle Scholar
  4. 4.
    Aroen A, Loken S, Heir S, Alvik E, Ekeland A, Granlund OG, Engebretsen L. Articular Cartilage Lesions in 993 Consecutive Knee Arthroscopies. Am J Sports Med. 2004;32:211–215.CrossRefPubMedGoogle Scholar
  5. 5.
    Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br. 2007;89:893–900.CrossRefPubMedGoogle Scholar
  6. 6.
    Barber-Westin SD, Noyes FR, McCloskey JW. Rigorous statistical reliability, validity, and responsiveness testing of the Cincinnati Knee Rating System in 350 subjects with uninjured, injured, or anterior cruciate ligament-reconstructed knees. Am J Sports Med. 1999;27:402–416.PubMedGoogle Scholar
  7. 7.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMedGoogle Scholar
  8. 8.
    Billings A, Scott DF, Camargo MP, Hofmann AA. High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up. J Bone Joint Surg Am. 2000;82:70–79.PubMedGoogle Scholar
  9. 9.
    Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331:889–895.CrossRefPubMedGoogle Scholar
  10. 10.
    Buckwalter JA. Articular cartilage: composition, structure, response to injury, and methods of facilitating repair. In: Ewing J, ed. Articular Cartilage and Knee Joint Function: Basic Science and Arthroscopy. New York, NY: Raven Press; 1990:19–56.Google Scholar
  11. 11.
    Bullens PH, van Loon CJ, de Waal Malefijt MC, Laan RF, Veth RP. Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplasty. 2001;16:740–747.CrossRefPubMedGoogle Scholar
  12. 12.
    Centers for Disease Control and Prevention. Prevalence of disabilities and associated health conditions among adults-United States, 1999. MMWR Morb Mortal Wkly Rep. 2001;50:120–125.Google Scholar
  13. 13.
    Centers for Disease Control and Prevention. Prevalence of self-reported arthritis or chronic joint symptoms among adults-United States, 2001. MMWR Morb Mortal Wkly Rep. 2002;51:948–950.Google Scholar
  14. 14.
    Centers for Disease Control and Prevention. Prevalence of doctor-diagnosed arthritis and possible arthritis-30 states, 2002. MMWR Morb Mortal Wkly Rep. 2004;53:383–386.Google Scholar
  15. 15.
    Cicuttini F, Ding C, Wluka A, Davis S, Ebeling PR, Jones G. Association of cartilage defects with loss of knee cartilage in healthy, middle-age adults: a prospective study. Arthritis Rheum. 2005;52:2033–2039.CrossRefPubMedGoogle Scholar
  16. 16.
    Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am. 1993;75:196–201.PubMedGoogle Scholar
  17. 17.
    Davies-Tuck ML, Wluka AE, Wang Y, Teichtahl AJ, Jones G, Ding C, Cicuttini FM. The natural history of cartilage defects in people with knee osteoarthritis. Osteoarthritis Cartilage. 2008;16:337–342.CrossRefPubMedGoogle Scholar
  18. 18.
    DeBock GH, Kaptein AA, Touw-Otten F, Mulder J. Health-related quality of life in patinets with osteoarthritis in a family practice setting. Arthritis Care Res. 1995;8:88–93.CrossRefGoogle Scholar
  19. 19.
    Deehan DJ, Murray JD, Birdsall PD, Pinder IM. Quality of life after knee revision arthroplasty. Acta Orthop. 2006;77:761–766.CrossRefPubMedGoogle Scholar
  20. 20.
    Dexter P, Brandt K. Distribution and predictors of depressive symptoms in osteoarthritis. J Rheumatol. 1994;21:279–286.PubMedGoogle Scholar
  21. 21.
    Ehrich EW, Davies GM, Watson DJ, Bolognese JA, Seidenberg BC, Bellamy N. Minimal perceptible clinical improvement with the Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire and Global Assessments in patients with osteoarthritis. J Rheumatol. 2000;27:2635–2641.PubMedGoogle Scholar
  22. 22.
    Ethgen O, Vanparijs P, Delhalle S, Rosant S, Bruyere O, Reginster J-Y. Social support and health-related quality of life in hip and knee osteoarthritis. Qual Life Res. 2004;13:321–330.CrossRefPubMedGoogle Scholar
  23. 23.
    Felson DT. An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin North Am. 2004;42:1–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Gillogly SD, Voight M, Blackburn T. Treatment of articular cartilage defects of the knee with autologous chondrocyte implantation. J Orthop Sports Phys Ther. 1998;28:241–251.PubMedGoogle Scholar
  25. 25.
    Gioe TJ, Novak C, Sinner P, Ma W, Mehle S. Knee arthroplasty in the young patient: survival in a community registry. Clin Orthop Relat Res. 2007;464:83–87.PubMedGoogle Scholar
  26. 26.
    Goldsmith CH, Boers M, Bombardier C, Tugwell P. Criteria for clinically important changes in outcomes: development, scoring and evaluation of rheumatoid arthritis patient and trial profiles. OMERACT committee. J Rheumatol. 1993;20:561–565.PubMedGoogle Scholar
  27. 27.
    Gooding CR, Bartlett W, Bentley G, Skinner JA, Carrington R, Flanagan A. A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: Periosteum covered versus type I/III collagen covered. Knee. 2006;13:203–210.CrossRefPubMedGoogle Scholar
  28. 28.
    Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D. Health-related quality of life after knee replacement. J Bone Joint Surg Am. 1998;80:163–173.PubMedGoogle Scholar
  29. 29.
    Install JN, Dorr LD, Scott RD, Scott WN. Rationale of the knee society clincial rating system. Clin Orthop Relat Res. 1989;248:13–14.Google Scholar
  30. 30.
    Jaeschke J, Singer J, Guyatt G. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10:407–415.CrossRefPubMedGoogle Scholar
  31. 31.
    Karabatsos B, Mahomed NN, Maistrelli GL. Functional outcome of total knee arthroplasty after high tibial osteotomy. Can J Surg. 2002;45:116–119.PubMedGoogle Scholar
  32. 32.
    Kazakos KJ, Chatzipapas C, Verettas D, Galanis V, Xarchas KC, Psillakis I. Mid-term results of total knee arthroplasty after high tibial osteotomy. Arch Orthop Trauma Surg. 2008;128:167–173.CrossRefPubMedGoogle Scholar
  33. 33.
    Koskinen E, Eskelinen A, Paavolainen P, Pulkkinen P, Remes V. Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis: a follow-up study of 50,493 knee replacements from the Finnish Arthroplasty Register. Acta Orthop. 2008;79:499–507.CrossRefPubMedGoogle Scholar
  34. 34.
    Lavernia C, Lee DJ, Hernandez VH. The increasing financial burden of knee revision surgery in the United States. Clin Orthop Relat Res. 2006;446:221–226.CrossRefPubMedGoogle Scholar
  35. 35.
    Lonner JH, Hershman S, Mont M, Lotke PA. Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis. Clin Orthop Relat Res. 2000;380:85–90.CrossRefPubMedGoogle Scholar
  36. 36.
    Luck JV. The lower extremities. In: Cocchiarella L, Anderson GBJ, eds. Guides to the Evaluation of Permanent Impairment. 5th ed. Chicago, IL: American Medical Association; 2001:546–548.Google Scholar
  37. 37.
    Madan S, Ranjith RK, Fiddian NJ. Total knee replacement following high tibial osteotomy. Bull Hosp Jt Dis. 2002;61:5–10.PubMedGoogle Scholar
  38. 38.
    Mankin HJ. Current concepts review. The response of articular cartilage to mechanical injury. J Bone Joint Surg Am. 1982;64:460–466.PubMedGoogle Scholar
  39. 39.
    Mankin HJ, Mow VC, Buckwalter JA. Articular cartilage repair and ostearthritis. In: Buckwalter JA, Einhorn TA, Simon SR, eds. Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System. 2nd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2000.Google Scholar
  40. 40.
    Meding JB, Keating EM, Ritter MA, Faris PM. Total knee arthroplasty after high tibial osteotomy. Clin Orthop Relat Res. 2000;375:175–184.CrossRefPubMedGoogle Scholar
  41. 41.
    Meding JB, Keating EM, Ritter MA, Faris PM. Total knee arthroplasty after high tibial osteotomy. A comparison study in patients who had bilateral total knee replacement. J Bone Joint Surg Am. 2000;82:1252–1259.PubMedGoogle Scholar
  42. 42.
    Minas T. Autologous chondrocyte implantation for focal chondral defects of the knee. Clin Orthop Relat Res. 2001;391S:S349–S361.CrossRefGoogle Scholar
  43. 43.
    Minas T. Autologous Chondrocyte Implantation in the Arthritic Knee. Orthopedics. 2003;26:945–947.PubMedGoogle Scholar
  44. 44.
    Minas T. Autologous Chondrocyte Implantation in the Osteoarthritic Knee. In: Cole BJ, Malek MM, eds. Articular cartilage lesions: A practical guide to assessment and treatment. New York: Springer; 2004:105–118.Google Scholar
  45. 45.
    Minas T, Peterson L. Advanced techniques in autologous chondrocyte transplantation. Clin Sports Med. 1999;18:13–44.CrossRefPubMedGoogle Scholar
  46. 46.
    Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP. A Controlled Trial of Arthroscopic Surgery For Osteoarthritis of the Knee. N Engl J Med. 2002;347:81–88.CrossRefPubMedGoogle Scholar
  47. 47.
    Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, Dragomir A, Kalsbeek WD, Luta G, Jordan JM. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59:1207–1213.CrossRefPubMedGoogle Scholar
  48. 48.
    NIH. NIH Consensus Statement on total knee replacement December 8–10, 2003. J Bone Joint Surg Am. 2004;86-A:1328–1335.Google Scholar
  49. 49.
    Noyes FR, Barber-Westin SD. Arthroscopic-assisted allograft anterior cruciate ligament reconstruction in patients with symptomatic arthrosis. Arthroscopy. 1997;13:24–32.PubMedCrossRefGoogle Scholar
  50. 50.
    Noyes FR, Barber SD, Mooar LA. A rationale for assessing sports activity levels and limitations in knee disorders. Clin Orthop Relat Res. 1989;246:238–249.PubMedGoogle Scholar
  51. 51.
    Noyes FR, Barber SD, Simon R. High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees: A two to seven year follow-up study. Am J Sports Med. 1993;21:2–12.CrossRefPubMedGoogle Scholar
  52. 52.
    Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752–757.PubMedGoogle Scholar
  53. 53.
    Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A. Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med. 2002;30:2–12.PubMedGoogle Scholar
  54. 54.
    Peterson L, Minas T, Brittberg M, Lindahl A. Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation - Results at two to ten years. J Bone Joint Surg Am. 2003;85-A:17–24.PubMedGoogle Scholar
  55. 55.
    Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A. Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 2000;374:212–234.CrossRefPubMedGoogle Scholar
  56. 56.
    Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg. 2003;85:259–265.PubMedGoogle Scholar
  57. 57.
    Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71:262–267.PubMedCrossRefGoogle Scholar
  58. 58.
    Rozkydal Z, Pink T. [Total knee replacement following high tibial osteotomy]. Acta Chir Orthop Traumatol Cech. 2003;70:158–163.PubMedGoogle Scholar
  59. 59.
    Saleh KJ, Arendt EA, Eldridge J, Fulkerson JP, Minas T, Muhall KJ. Symposium. Operative treatment of patellofemoral arthritis. J Bone Joint Surg. 2005;87-A:659–670.Google Scholar
  60. 60.
    Sheng PY, Konttinen L, Lehto M, Ogino D, Jamsen E, Nevalainen J, Pajamaki J, Halonen P, Konttinen YT. Revision total knee arthroplasty: 1990 through 2002. A review of the Finnish arthroplasty registry. J Bone Joint Surg Am. 2006;88:1425–1430.CrossRefPubMedGoogle Scholar
  61. 61.
    Sprenger TR, Doerzbacher JF. Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am. 2003;85-A:469–474.PubMedGoogle Scholar
  62. 62.
    Stukenborg-Colsman C, Wirth CJ, Lazovic D, Wefer A. High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7-10-year follow-up prospective randomised study. Knee. 2001;8:187–194.CrossRefPubMedGoogle Scholar
  63. 63.
    Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, Bombardier C, Felson D, Hochberg M, Heijde Dvd, Dougados M. Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann Rheum Dis. 2005;64:34–37.CrossRefPubMedGoogle Scholar
  64. 64.
    van Raaij TM, Bakker W, Reijman M, Verhaar JA. The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study. BMC Musculoskelet Disord. 2007;8:74.CrossRefPubMedGoogle Scholar
  65. 65.
    Vazquez-Vela Johnson G, Worland RL, Keenan J, Norambuena N. Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement. J Bone Joint Surg Br. 2003;85:52–56.CrossRefPubMedGoogle Scholar
  66. 66.
    Ware J, Sherbourne C. The MOS 36-item short form health survey (SF-36): conceptual framework and item selection. Med Care. 1992;30:473–483.CrossRefPubMedGoogle Scholar
  67. 67.
    Ware JE, Kosinski M, Keller SD. SF-36 Physical and Mental Health Summary Scales: A User’s Manual. 5th ed. Boston, MA: Health Assessment Lab; 1994.Google Scholar
  68. 68.
    Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey: Manual & Interpretation Guide. Vol 2. Boston, MA: The Health Institute; 1997.Google Scholar
  69. 69.
    Yelin E, Lubeck D, Holman H, Epstein W. The impact of rheumatoid arthritis and osteoarthritis: the activities of patients with rheumatoid arthritis and osteoarthritis compared to controls. J Rheumatol. 1987;14:710–717.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Tom Minas
    • 1
    • 2
  • Andreas H. Gomoll
    • 1
    • 2
  • Shahram Solhpour
    • 1
    • 2
  • Ralf Rosenberger
    • 1
    • 2
  • Christian Probst
    • 1
    • 2
  • Tim Bryant
    • 1
    • 2
  1. 1.Cartilage Repair CenterBrigham & Women’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA

Personalised recommendations