There are numerous surgical options to alleviate the symptoms and consequences of osteoarthritis and thus significantly improve the quality of life. The following therapy options exemplify the possibilities for knee joint arthrosis (gonarthrosis):
- Symptomatic surgical methods for joint preservation:
- Lavage* (irrigation of the knee joint).
- Shaving (technique to obtain replacement tissue).
- Debridement* (rehabilitation of the wound bed by removing necrotic and fibrinous coatings).
- Bone stimulating surgical methods (marrow stimulation):
- Pridie drilling – tapping of cartilage defects to break through the underlying bone layer and allow sprouting of blood vessels and thus regeneration of tissue by replacement cartilage (technique for obtaining replacement tissue).
- Microfracturing – placing a small bone defect to trigger repair mechanisms in a joint with cartilage damage (technique for obtaining replacement tissue).
- Abrasionplasty – in the course of an arthroscopy (arthroscopy of the joint), the residual cartilage in the defect area is removed with a cutter down to the subchondral bone layer (radiologically recognizable “hardening” of the bone under the cartilage surface of a joint). In this process, similar to microfracturing, there is a washout of mesenchymal stem cells (MSCs) from the bone marrow from the subchondral bone into the defect area; Indication: circumscribed cartilage damage.
- Advanced therapy options:
- Joint surface restitution (for cartilage defects > 1 cm²).
- autologous chondrocyte transplantation (ACT; synonyms: autologous cartilage transplantation; autologous chondrocyte cell transplantation) – in two surgical steps, the patient’s own chondrocytes (cartilage cells) are first harvested, cultivated ex vivo ((lat. “outside the living”), and then, in a second, open operation, implanted, i.e. The standard procedure is matrix-associated transplantation (MACI), in which the chondrocytes are applied to a collagen carrier substance in the laboratory. In the future, the procedure may be traded as an advanced therapy medicinal product (ATMP). Approval has been granted by the European Medicines Agency (EMA) for the repair of symptomatic articular cartilage defects of the femoral condyle (distal articular process (condyle) of the thigh bone (femur)) and the patella (kneecap) up to a size of 10 cm2.Indications: traumatic or degenerative damage to articular cartilage; isolated cartilage damage with stable defect marginsSuitable parameters for patient selection are:
- Size of the defect: > 2.5 cm² in young active patients, otherwise > 3-4 cm².
- Defect type: isolated or focal cartilage damage.
Negative predictors of outcome:
- Female gender, older age, long-standing complaints, multiple prior surgeries, presence of multiple defects, patellofemoral location (compartment between patella and femoral fossa).
- Osteochondral transplantation (OCT) – use of an autologous or an allogeneic graft (cartilage-bone graft) for defect treatment.
- autologous chondrocyte transplantation (ACT; synonyms: autologous cartilage transplantation; autologous chondrocyte cell transplantation) – in two surgical steps, the patient’s own chondrocytes (cartilage cells) are first harvested, cultivated ex vivo ((lat. “outside the living”), and then, in a second, open operation, implanted, i.e. The standard procedure is matrix-associated transplantation (MACI), in which the chondrocytes are applied to a collagen carrier substance in the laboratory. In the future, the procedure may be traded as an advanced therapy medicinal product (ATMP). Approval has been granted by the European Medicines Agency (EMA) for the repair of symptomatic articular cartilage defects of the femoral condyle (distal articular process (condyle) of the thigh bone (femur)) and the patella (kneecap) up to a size of 10 cm2.Indications: traumatic or degenerative damage to articular cartilage; isolated cartilage damage with stable defect marginsSuitable parameters for patient selection are:
- Articular realignment osteotomy (synonym: corrective osteotomy) – surgical procedure in which a bone is cut (osteotomy) to restore the normal anatomy of bones, joints, or extremities
- Joint surface restitution (for cartilage defects > 1 cm²).
- Joint replacement* * (e.g., knee arthroplasty/partial knee arthroplasty/total joint arthroplasty (artificial replacement of the complete joint, i.e., the condyle and the socket); the complication rate as well as the mortality rate (death rate) after partial knee arthroplasty is lower than after total joint arthroplasty; the disadvantage of partial knee arthroplasty is that it must be replaced earlier than total joint arthroplasty)
* Numerous studies show that no benefit can be established for therapeutic arthroscopy with lavage and, if necessary, additional debridement compared with a nonactive comparative intervention (e.g., no efficacy documented for elderly patients with mild gonarthrosis (knee joint osteoarthritis)). * * The question of whether joint replacement is indicated is decided by the patient’s symptoms and level of suffering and not solely by the radiograph.
