There is a transplant that keeps professional athletes in the game and works the same way to keep regular patients on their feet. For young adults not yet ready for joint replacement and who can’t go the distance living with debilitating pain, donor cartilage comes into play.
An intact, healthy piece of cartilage orthopedic surgeon Dr Brian Cole will transplant in his patient’s knee is about the size of a quarter. The procedure is called an osteochondral allograft. But before Dr Cole, professor orthopedic surgery at Rush University Medical Center, could do the surgery, he needed donor tissue.
Think of it like an organ donation.
“Someone who would otherwise donate their heart, liver and lungs also donate their cartilage,” Dr Cole said. “Typically they are very young donors. Most of them have died in traumatic accidents and things of that nature but we utilize their cartilage to treat local spots of arthritis.” Once the donor cartilage is tested and deemed safe for transplant – a process that takes about 14 days — the graft is pressed right into the defective area.
It’s not a new concept – and the surgical intervention is rare compared to the number of joint replacements performed annually. Still, with about 2500 to 3000 grafts performed each year, surgeons now have a larger collection of outcomes to consider. “We have about an 85% satisfaction rate with conditions that are lasting up to 10 to 12 years now,” Cole said.
That means the graft is often an effective bridging technique, particularly for a select group of patients with cartilage loss who are too young for total knee replacement. “When this goes well, we don’t worry about them going back to very high level activities,” Dr. Cole says. “No restrictions whatsoever, even professional sports. In contrast with metal and plastic that’s just not an option.”
She’s not be a professional athlete, but Kirstin Kent’s knee once threatened her career in the same way. On her feet for long shifts at Shriner’s Hospital for Children in Chicago, the constant pain limited her ability to do the job she loves.
“It was really hard. At work I wouldn’t be able to move around much. I pretty much was stuck in my office and I would try to do as much as I could but I kept telling people, ‘I’m not lazy, I’m just in so much pain I can’t really move around,’” she said. “I wasn’t able to help other co-workers with their tasks for the day, and I would really limit where I would go. I wouldn’t go grocery shopping at night. I wouldn’t be able to go out and do anything. I would just basically sit at home because I was in so much pain.”
“She had an area of cartilage loss behind her knee cap where the bone was exposed and then the groove that the knee cap tracks in was also had exposed bone,” said Dr Cole. “We took this donor’s patella and transplanted it into her knee and then the same thing for the groove that the knee tracks in.” It was a calculated risk. Kirstin was nearly too old for the allograft. The transplant works best on younger patients who don’t have the arthritic changes and degenerative disease that often come with age.
But Kirstin and Dr Cole were willing to take a chance.
“What we’re learning is if we push the envelope many of these patients can also be helped with the same technology we also apply to our other age groups,” Dr Cole said. “I was told that I was too young to get a knee replacement and that I would need too many revisions down the road,” Kirstin said. “So really this was my last option. I feel really, really good. I keep saying I never thought that I would see this day.”
Unlike an organ transplant cartilage transplant patients don’t need to take anti-rejection drugs. Recovery takes about 3 to 6 months – with most patients back to full activity after 8 months.