Condyle - Existing Treatments

Marrow Stimulation Techniques

 
Abrasion arthroplasty
In abrasion arthroplasty, a high-speed rotary burr or shaving device is used to remove about 1mm of bone from the surface of the lesion. This creates an exposed bone bed that will bleed and this will initiate a fibro-cartilage healing response. The fibro-cartilage then grows into and fills the hole or lesion creating a new but inferior surface. This technique can provide short-term (1-3 years) pain relief, but often patients are unable to resume their desired activity levels.
Microfacture/Microdrilling Technique
This technique is very similar to abrasion arthroplasty except that the bleeding is initiated by impacting awls, picks or drilling directly into the bone within the lesion.  A recent study has shown that patients begin to deteriorate 18 months post-microfracture surgery and that deterioration is more pronounced in patients over 40 years old.Articular defects that are larger than 15mm in diameter are generally believed to require a more aggressive intervention and are typically treated using one of the following approaches, most of which are performed as open surgery:

Autografts

MosaicPlasty^_® (or OATS)
This technique was popularized in the mid-1990s. In MosaicPlasty, a series of dowel cutting instruments are used to harvest one or more cylindrical plugs or grafts of articular cartilage and bone from the surrounding healthy tissue. These tube-like grafts are then implanted into the defect site. A series of these plugs placed in close proximity to one another is used to establish a new grafted hyaline cartilage surface. A limited number of surgical institutions are performing this procedure as it is technically very challenging. Outcomes for these patients have been reported as variable based on surgeon expertise, and patient selection. In addition, pain relief has been found to be inconsistent. A lengthy post-operative regime of non-weight bearing (up to 2-6 months) and continuous passive motion has also been identified as a major contributor to the success of this procedure.

Autologous Cell Transplantation

ACI (Carticel^®)
ACI is a therapeutic treatment whereby healthy hyaline cartilage cells are harvested from the patient, the cell counts are increased in vitro (outside the body) via some type of bioreactor expansion technique, and then those cells are injected back into the defect. It requires two surgeries. This technique is still considered somewhat experimental and expensive.
Total Joint Replacement

Total Knee Replacement (TKR)

For patients with large articular defects a procedure known as "total knee replacement" is often required. This procedure requires the removal of substantial amounts of bone followed by the implantation of a prosthetic device. Patients who undergo TKR often describe a restoration of lifestyle/activity that is profound; however, rehabilitation periods following this procedure are several months or even longer. While the useful life of a TKR is generally claimed to be up to 20 years, clinical evidence indicates that complications can begin to arise at approximately 8 - 10 years. Each successive TKR (commonly referred to as a "revision") has been shown to have a shorter useful life than the previous implant. With each revision, the amount of remaining good quality bone stock into which the implants are anchored becomes an issue. Bone loss as a result of tissue reaction, implant loosening, implant preparation, etc., can lead to great challenges in restoring a solid anchoring site for the implant. As the revision or replacement of these devices can lead to increased morbidity (complications) and result in a very difficult rehabilitation for older patients, efforts are made to forgo the TKR procedure for as long as possible. Therefore, there is a reluctance to use TKR in patients under 60 years of age. Similar concerns and issues are prevalent in total hip replacement procedures as well.

Unicompartment Knee Replacement (UKR)

Uni's are single condyle versions of total knee replacements. These devices still require both a femoral and tibial implant, but only one condyle of the femur is replaced rather than both.

Resurfacing Hemiarthroplasty

Hemiarthroplasty is the replacement of only one articular surface of a joint which means that only one half of the joint is resurfaced and as such a smaller amount of diseased tissue is being removed when compared to a total joint.
The HemiCAP implant is a rounded, cap-like implant made from a cobalt chrome alloy with a central post on the implanted, or bone side. Cobalt chrome is a material that has been used in total joint reconstruction devices for over two decades. This material has proven to provide a safe, effective and strong weight-bearing surface in joints. The CAP system precisely aligns the surface of the implant to the contours of the patient's articular cartilage surface, thus filling the defect and restores a smooth and continuous articulating surface.
Arthrosurface believes that the HemiCAP implant will offer the following clinical benefits:

• Relief from current pain and swelling
• Return to normal activity with rapid recovery time
• Restoration of a smooth, continuous, articulating load-bearing surface.
• A simple and reproducible outpatient/ambulatory surgical procedure

**The Femoral Condyle system is available in most international markets via CE mark and in the US it is currently being evaluated as part of a IDE clinical study at a number of sites in the US.**