Amid the hustle and bustle of holiday shopping, you bend down to pick up that perfect gift from the bottom shelf and — feel a sharp pain in your knee. Arthritis is the furthest thing from your mind — you couldn’t be old enough for a joint disease. Surprisingly, early stages of arthritis begin in your 20’s and 30’s and by the time you are in your 40’s and 50’s the damage is done.
According to the December 9, 2002, TIME magazine cover story, Americans “are headed for an epidemic of joint disease … at present doctors believe that osteoarthritis affects more than 20 million Americans and by the year 2020 that number is expected to reach 40 million people.” Based on these startling statistics, new research focuses on new treatment options and prevention practices.
San Francisco-based Kevin R. Stone, M.D., founder of The Stone Foundation for Sports Medicine and Arthritis Research and The Stone Clinic, is a leading authority in arthritis research, treatment and prevention. His research focuses on biological treatment of arthritic joints as opposed to using artificial material to repair damaged joints. This biological treatment of joints is advantageous for several reasons: it can last longer that the artificial material that has a limited lifetime, it is less prone to rejection and infection, and in many cases, the cost of treatment is less.
According to Stone, “Younger people suffering from joint pain are opting for treatment using the biological material because the data clearly shows that repairing cartilage is better than removing it, and replacing cartilage with cartilage is better than using artificial materials that wear out in 10-20 years.” Patients including professional athletes, celebrities and politicians, seek out Stone, who specializes in this type of joint repair.
Two of the most popular treatments include biological knee replacement and meniscus transplantation (replacing the shock absorbers in the knee).
Biological Knee Replacement:
Most recently, advances in instrumentation have permitted doctors to develop new techniques to regrow damaged areas of cartilage. Doctors can now harvest articular cartilage and bones from people’s knees and make a paste out of that tissue. Paste grafting allows physicians to repair arthritic defects of traumatic defects (from sports injuries, etc.) in articular cartilage, the smooth surface that covers the joint. This new procedure, biological knee replacement, is done in a one step arthroscopic procedure. Healthy cartilage is removed from another portion of the joint, ground into a paste and placed onto the portion of the joint that is injured. Ironically, the joint is traumatized further, so that blood is drawn allowing the paste to stick to the joint and subsequently grow.
In contrast, many still use the Swedish method, a commonly used procedure that requires two surgeries-one to remove the cartilage and grow it in a Petri dish and another to paste it in once the cartilage is regrown. Another option for these types of injuries is total knee replacement, often avoided or discouraged if the patient is young.
Meniscus Transplantation (replacing the shock absorbers in the knees)
While there has been a lot of publicity surrounding re-growing of cartilage for small defects in the knee, people with significant arthritis have been told to go home, rest and wait for their knee replacement when the pain becomes too much to bear. This advice sits poorly with active baby boomers that expect to be able to continue to exercise until a very old age.
To buy time, diminish their pain and keep them exercising, a few surgeons in the U.S. and Europe have been replacing the knees natural shock absorbers, the meniscus cartilage, with a complete meniscus from a cadaver, called an allograft meniscus. “The tragedy of a death of a young person can be diminished a little bit by their gift of the meniscus cartilage to keep another person active,” says Stone. “In a recent multi-year follow-up study, we have found a good success rate in over 70 transplanted meniscal allografts in significantly arthritic knees. “While we have no pretense that we will make these knees normal, nor that it will last forever, it does permit the patient with an arthritic compartment to exercise and live more of a pain free life on a new shock absorber without the fear of loosening an artificial component that total knees bring.”
Until recently, physicians relied heavily on procedures such as a total knee replacements or repairing only the cartilage without regard for the cushioning between the joints. Recent studies provide results indicating that the meniscus replacement is a viable option and can relieve severe knee pain. The procedure is often combined with articular cartilage grafting such as a paste graft technique also originally developed by Stone in 1991. The cartilage grafting procedures are expected to have a higher success rate if combined with the protection of a new meniscus shock absorber.
The first meniscus transplantation was performed in Germany in 1986. Shortly thereafter, the procedure was performed in the United States. Since then, approximately 4,000 meniscus transplantations have been performed in the US predominantly in knees that did not have arthritic changes. What this new study shows is that even in the arthritic knee, there is benefit to replacing the shock absorber. Stone notes that the failure rate of meniscus transplantation is higher in the arthritic knee as expected with a 30% re-tear rate in the first few years. However, most of the re-tears were able to be treated with an arthroscopic procedure. Seven of the 70 arthritic knees went on to a unicompartment knee replacement during the study, which successfully relieved the knee pain.