Osteoarthritis (worn cartilage) is the most common joint condition. The most common form of osteoarthritis is osteoarthritis of the knee. Osteoarthritis of the knee causes chronic pain and limits movement. The cartilage in the knee wears away over many years. Since the cartilage has no sensitive nerve endings (pain sensors), damage is only noticed when the defects already affect the bone beneath the cartilage.
A cartilage transplant, or cartilage cell or chondrocyte transplant, is a new surgical procedure: in which cartilage damage is repaired using cartilage cells from the patient’s own body. Few knee specialists in Germany successfully perform this procedure. Dr Baum was the first physician in the world to perform an entirely arthroscopic cartilage transplant of the knee. He co-developed this procedure and trained other physicians in this surgical procedure.
Patients benefitting from the regeneration of their cartilage with autologous cartilage transplantation, can enjoy something that no generation before them was able to experience: enhanced agility, flexibility and overall knee performance.
Cartilage cells are vital as cushions inside the joints of the body. Healthy cartilage tissue keeps joints smooth, flexible and pain free. If the cartilage tissue becomes damaged, this damage tends to be permanent. Joints become painful and lose their flexibility. Cartilage cannot regenerate naturally inside the body.
After some time the bones start to collide. The joints start to become inflamed and permanently stiff, unless a prosthetic joint is implanted. This painful process represents the irreversible development of osteoarthritis.
Cartilage transplantation is not advisable for all patients. Ideally patients are between 15 and 55 years of age, although this is flexible.
If fitness and the general level of health is good, active people up to the age of 65 years have successfully received cartilage transplants and have gone on to enjoy sports such as skiing once more.
The following factors are more likely to be a barrier to successful transplants than the age of the patient:
The patient is overweight (excess weight puts strain on joints) Solution: presurgery weight control.
Malalignment of the bones in the leg eg. bow leggedness. Solution: malalignment can be addressed by osteotomy during the same surgical appointment as cartilage transplant.
Joint surfaces opposite the area of damaged cartilage are also rough (often as a result of trauma), in this case a metal implant (Repicci inlay) has to be fitted.
There is a genetically determined weakness in the cartilage tissue. Solution: partial or full prosthesis.
Instability of the knee due to damaged ligaments. Solution: ligaments must be reconstructed e.g. by ACL reconstruction
Instability of the knee due to missing or severely damaged meniscus. Solution: A Repicci inlay might be preferable.
The area of the cartilage defect is too large (greater than 10 cm). Solution: the surgeon may recommend a joint preserving Repicci inlay.
Due to another medical condition or very old age a quick recovery (weight bearing) time is important. Solution: in this case a Repicci inlay might be more suitable due to the possibility of full weight bearing on the day after surgery.
Directly after transplantation the cartilage cells are a soft jelly like substance. They will not have the thickness and resilience of the surrounding cartilage. This is comparable to a newly sown lawn. Just as new grass must be protected from heavy use e.g. football being played on it, the newly implanted cartilage must be protected from full weight-bearing activity. On the third day following the operation, the patient may leave the hospital. As standing or walking unaided is not possible for the next six weeks, the patient must use crutches and later on a walking stick.