Welcome to the ICRS Patient & Public Education Site

If you suffer from joint pain, you’re not alone. Each year, more than 50 million people visit their doctors because of joint pain — half of them with a damage of the articular cartilage.

On this website, you can find useful, updated information on specific cartilage-related conditions and possible treatments options, written by world-renowned experts in this field, helpful patient information to read and download, and other useful resources

The choice of procedures depends on the size and location of cartilage defect. Larger defects are typically treated with autologous chondrocyte transplantation, osteochondral allograft transplantation, or newer synthetic or natural scaffolds which may require open incisions. Smaller defects in specific locations may be treated with enhanced bone marrow stimulating techniques, autologous chondrocyte implantation (ACI), or osteochondral autograft transfer which may be completed through the arthroscope. There is also a chapter for conservative treatments options and rehabilitation after cartilage repair.

Intended Audience for this Website

People of all ages can suffer from cartilage complications, whether due to ‘wear and tear’ or injury. While the former is much more common in middle-aged patients, and even more so in women, injuries to the joints, such as trauma or accidents during active sports, can affect any age group or gender. Careers requiring repetitive or intense motion can increase the risk of developing cartilage problems, but there are several other risk factors, including age, weight and genetic predisposition.

What is Cartilage Repair?

On this website, we focus only on articular cartilage repair treatments, which means the restoration of damaged hyaline cartilage in the joints. Cartilage repair and regeneration is a treatment for joints that have damaged cartilage but are otherwise healthy. Typically, these procedures are recommended for cartilage damage or deterioration caused by:

Injury or trauma, including sports injuries or repetitive use of the joint Congenital abnormalities – abnormalities a person is born with (for instance misalignment) – that affect normal joint structure Hormonal or idiopathic disorders that affect bone and joint development, such as osteochondritis dissecans (OCD). There are several types of new and modern procedures for cartilage repair and regeneration techniques that are designed to heal the cartilage by filling the cartilage defect (pothole) with repair tissue.

What is not covered in this Website?

There are several types of bone and joint pain, each with many potential sources or etiologies. This site is not intended for people who suffers from rheumatoid arthritis (RA), gout, avascular necrosis (AVN), and cancer within bones, osteoporosis and other inflammatory or autoimmune diseases.

Acknowledgements

To the Mäxi Foundation: 
This website project would not have been possible without the substantial support of the Swiss “Mäxi Foundation”. The ICRS would like to express a deep gratitude for this very generous contribution to the International Cartilage Repair Society and the respective patient community, making it possible to provide updated information about cartilage damage and cartilage repair technologies free of charge to all interested persons.

To the Authors & Contributors:
The following world-renowned experts in cartilage repair & cartilage research have contributed to the extensive content of this website: Stephen Abelow (USA), William Bugbee (USA), Susan Chubinskaya (USA), Brian Cole (USA), Stefano Della Villa (IT), Chris Erggelet (CH), Jack Farr (USA), Ralph Gambardella (USA), Michael Gerhardt (USA), Wayne Gersoff (USA), Alan Getgood (CA), Alberto Gobbi (IT), Laszlo Hangody (HU), Oliver Kessler (CH), Elizaveta Kon (IT), Jos Malda (NL), Bert Mandelbaum (USA), Tom Minas (USA), Kai Mithoefer (USA), Stefan Nehrer (AT), Lars Peterson (SE), Scott Gillogly (USA), Holly Silvers (USA), Jason Theodosakis (USA) and Kenneth Zaslav (USA)

To anyone else who contributed to this important project
ICRS Office Staff, Medical Writers, Committees, Illustrators and Web Developers, etc.

Terms of Use

These terms of use, together with our Privacy Policy collectively, these “Terms of Use”, governs access to and any use of the website cartilage.org and any sub-sites (the “Website“), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree to bound and abide by the Terms of Use on behalf of all users of the respective computer. Visitors who do not agree with these Terms of Use must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) may revise and update these Terms of Use from time to time in our sole discretion. All changes are effective immediately when we post them. Your continued use of the Website following the posting of revised Terms of Use means that you accept and agree to the changes. You are expected to check this page from time to time so that you are aware of any changes, as they are binding on you.

The information on the Website is not intended to treat, diagnose, cure or prevent any cartilage related issues. Always seek the advice of a physician or other qualified health care provider with any questions you have regarding your medical condition.

Privacy Policy

This privacy policy (“Privacy Policy”), together with the Terms of Use for the patient website section, applies to any use of the website cartilage.org and any sub-sites (the “Website”), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree on behalf of all users of the respective computer to be bound and abide by the Terms of Use and this Privacy Policy. Visitors who do not agree with the Terms of Use and this Privacy Policy must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) is committed to protecting your privacy and ensuring that your personal information is protected. This Privacy Policy explains the types of personal information we collect and how we use, disclose and protect that information.

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Joint Resurfacing & Joint Replacement

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Joint Resurfacing & Joint Replacement

As a person ages, particularly from 40 years onwards, there is an increasing chance if they have the unfortunate factors of genetics, a period of obesity or high knee stress activity that they will develop pain in the joints that will not respond to non-operative treatment. This will most likely be due to wear and tear of the cartilage – the thin tissue layer that coats the surfaces of joint bones—you may have seen this on the end of chicken bones. When cartilage is damaged, pain and ultimately disability may occur. This is known as degenerative joint disease or osteoarthritis.

In the early stages of cartilage degeneration, small potholes or cavities can develop—see other chapters on how this “potholes” can be treated. As you are reading this chapter, you probably no longer have isolated “potholes”, but rather the entire “road” of your knee is involved. With current cartilage restoration options, there are no reliable biological treatments. That is ‘bone-on-bone’ arthritis typically requires alternative management.

Once this stage is reached, common cartilage repair procedures that could otherwise help repair the damage (such as ACI or other transplantation or graft procedures explained on this website) are no longer effective. In such cases, reshaping or replacing the joint (arthroplasty) or invasive procedures that cut, shorten or realign the bones (osteotomy) are considered. It is therefore important to monitor and treat these problems at an early stage, whenever possible.

A recently developed technique has the potential to plug these defects with small metallic inserts – similar to a larger-scale version of tooth filling in dentistry. The technique falls under the umbrella of ‘joint resurfacing’. While it is effective in cartilage problems, the plugs are not cartilage. It is therefore not the same as dedicated cartilage repair procedures that replace, stimulate or re-grow the body’s own cartilage tissue.

Arthroplasty and joint resurfacing procedures are most appropriate for people age over 40–50 years or older who, after assessment, have minimal or low probability of successful biological cartilage repair. Alternatively, joint resurfacing is indicated for people with failed cartilage repair procedures and are age appropriate for “metal and plastic”.

Patients who are obese, heavy smokers, or receiving prescription painkillers typically not only have poor cartilage repair outcomes but also less optimal outcomes for arthroplasty. For these patients there are no reproducible, quick or easy procedures.

People with physically demanding work lives, or those with an active personal lifestyle, are better suited to osteotomy and/or cartilage repair, where possible.

If the damage to the cartilage is irretrievable, too extensive or the patient’s lifestyle or career is more sedentary (e.g. office worker), joint arthroplasty (using a prosthesis) may be preferred. However, the individual’s circumstances will need to be assessed by the surgeon.

A tailor-made treatment and rehabilitation plan will be planned, depending on the diagnosis made by the surgeon. To understand more about the specific joint problem, and help decide which procedures are suitable, a ‘weight-bearing’ (that is, standing) X-ray is essential.

Taken while standing up and gently squatting, this assesses the joint under normal body loads. In other positions – such as lying down on the X-ray table – the imaging results can give a misleading impression of the alignment and joint spaces. Your surgeon will be happy to answer any questions you have about your diagnostic X-rays.

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about arthroplasty and joint resurfacing, as well as anyone interested in cartilage problems.

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Knee Resurfacing

What is arthroplasty?

If it is decided that a joint needs surgical artificial replacement, partial or total arthroplasty implants (metal and plastic) may be used, depending on the extent of the damage.

Taking the knee as an example, there are three major compartments that are commonly replaced: medial (towards inner thigh), lateral (outer side of leg) and patellofemoral (frontal, between the kneecap and thigh bone). Depending on need, dedicated replacements can be implanted separately into one or two of the compartments, or all three can replaced with a single total knee arthroplasty. More recently, bi-compartmental designs that fit two compartments with one single implant have also been developed, yet scientific scrutiny is need to tell if these are in the best interest of patients.

In addition, modern advances mean that it is now possible to perform a scan on a patient’s knee and send this information remotely to a prosthetic manufacturer. They can then custom-make a patient-specific implant with a unique fit, yet these “custom” implants have NOT been shown to be superior to standard implants.

What are the advantages of arthpoplasty?

Prosthetic replacements of knee compartments have been introduced since the 1970s and have highly reproducible results.

Single (unilateral) replacements of one part of the joint have a high degree of patient satisfaction, with recovery times, pain levels and surgical risks (blood loss, for example) all somewhat better than for total knee replacements. In addition, partial replacements still allow a great deal of bone, cartilage and ligament to be retained, which helps the implant to feel more natural.

What are the disadvantages of arthoplasty?

Especially in the case of total knee replacements, reports of discomfort or a ‘fake’ feeling in the knee are often noted. In addition, arthroplasty may limit knee bending, and patients need to manage their expectations as to what range of motion and activity they will be able to achieve after implantation.

In general, active pursuits that require excessive pivoting, or turning, and/or weight bearing (that is, no running or jumping) should be avoided, as there is risk of loosening or failure of the implant.

It is important to note that the life of any arthroplasty implant before failure is approximately 10–20 years for unilateral implants and 15-25 years for total knee implants. With this in mind, it is preferable to postpone knee replacement until at least middle age, wherever possible, as this will help the implant to last at least till the patient’s elderly years. If revisions of total joint replacement are necessary, elderly patients especially might be at increased risk of complications such as infection, diminished motion and pain.

What is joint resurfacing?

Joint resurfacing systems such as small metal implants are one surgical method for the treatment of cartilage defects in the major joints. In simple terms, it is a method for plugging cavities in the cartilage, to fill the defects and create a smooth and continuous surface using metal instead of a biologic.

Unlike bone replacement procedures, limited joint resurfacing ensures only minimal structural changes to the joint, and patients may be able to return to a normal, pain-free active life. While younger patients (less than 40 years of age) are likely to benefit from biological cartilage repair procedures, joint resurfacing is directed at those in their middle years (40–50 years of age) who require relief from painful cartilage joint problems, but do not have severe enough deterioration to require formal arthroplasty.

What are the advantages of joint resurfacing?

Patients undergoing joint resurfacing will be able to walk within a shorter time after surgery, and get back to activity soon.

What are the disadvantages of joint resurfacing?

The metal plugs that fill the cavities in the cartilage can create wear in the long term, and the long-term predictions are that there will be eventual failure years in the future. This is also true of other surgical approaches using synthetic components.

Consequently, the procedure should be considered more as an alternative for patients suitable for biological cartilage repair but otherwise are not suitable for candidates that do not require a full prosthetic implantation.

Frequently Asked Questions (FAQs)

How soon will it be before I can leave hospital after my surgery?

Again, this will depend on factors such as the type of implant, country of residence and your unique circumstances. You should be able to walk early after joint resurfacing, noting that partial or total knee arthroplasty may result in a short hospital stay, depending on the healthcare system in which you are cared for.

How long will my implant last?

This will depend on both the type of implant, and the circumstances after your operation that are unique to you. Many implants will be able to last for decades, that is the metal will not typically wear and the plastic will wear slowly. The major reason for implants failing is from “loosening from bone”. This has many reasons, but commonly include: over-stress or debris from plastic wear causing the body to “attack” the bone cement interface.

I have heard I will need to take antibiotics when visiting the dentist. Is this true?

Because you now have an artificial joint, care must be taken to prevent it getting infected. Dental work such as teeth cleaning, fillings or extractions (for example) can carry some low risk of infection, as can many other procedures (such as colonoscopies or other invasive procedures), which will need to be managed properly.

Depending on your unique circumstances, and your immune status (i.e. other health issues), enough time may have passed to no longer need prophylactic courses of antibiotics. Speak to your surgeon to find out what measures you need to take.

What practical considerations are there?

You surgeon will discuss all important considerations. In addition, there are many day-to-day practicalities that may need additional consideration. A common example is the question: do you need to provide proof of your implant in order to pass through metal scanners at airports. The answer is “No” as terrorists could get “arthroplasty cards” and thus these cards/proof are no not needed/honoured. Speak to your healthcare provider if you have any specific questions or concerns.

What limitations will I have following surgery?

It is essential to manage expectations, talk to your surgeon and keep activity after your operation to a safe level. To ensure the implants do not loosen or fracture, you should obey the surgeon’s activity recommendations.

Keywords

arthroplasty, Cartilage, Joint resurfacing, knee replacement

As a person ages,…
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