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Risks & Complications in Cartilage Repair
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Risks & Complications in Cartilage Repair

It is important to note that, in general, cartilage repair is a relatively low-risk, safe procedure, and complications are rare. However, as with any surgery, being aware of the risks – both in general and for a specific individual – is important as any decision made over surgery is a fully informed one.

While by no means exhaustive, the following information offers a background to some of the risks that should be considered for elective (planned) cartilage surgery.

However, it is very important that a patient engages with their healthcare professional in a proactive dialogue. The information here therefore merely helps to form the basis of a discussion between a patient and their doctor, and offer some initial insights into areas that may need further thought.

Depending on the joint in question, cartilage repair procedures carry different risks and benefits, each of which need to be considered carefully. In addition, individual patient circumstances, including other health concerns, such as long-standing disease, need to be factored in when undergoing anaesthesia and surgery.

With this in mind, some of the information contained within may provide a starting point for patients to bring up any concerns they have with their healthcare provider.

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 cartilage repair and physiotherapy following surgery, as well as anyone interested in cartilage problems.

What risks or complications should I know about?

Surgery in general

The general risks of surgery (i.e., not specific to cartilage repair) are the first area for discussion. Bleeding and infection, while uncommon, can significantly affect outcomes, especially in older patients.

Although strokes, blood clots, blood clots going to the lungs and heart attacks (myocardial infarction) caused by complications within the circulation are extremely rare in young and fit patients, they can be more common in those with underlying medical conditions.

Tobacco use increases the risk of infection and other complications, and has a serious negative effect on the outcome of any type of cartilage repair.

Many coexisting health concerns, such as heart disease or obesity, can have their impact on the outcome minimised before an operation, ensuring the best situation for the patient. A collaborative, or ‘multidisciplinary’, approach will help the surgical team to minimise the risk of complications.

The use of anaesthesia carries some risks, but most of these are mild, temporary issues related to the agents used, the process of intubation or the use of nerve blocks. Extremely rare instances of severe allergic reaction have been reported, and death is reported in approximately 1 in 100,000 patients undergoing general anaesthesia.

Cartilage repair

Looking at cartilage repair procedures in particular, more than one procedure may be required. While most cartilage procedures are single-stage techniques, cartilage repair may be planned over several procedures at different times. In two-stage procedures such as autologous chondrocyte implantation (ACI), cartilage cells (chondrocytes) are harvested from the body (initial operation), multiplied in a laboratory, and then surgically replanted into the cartilage defect (second operation).

While rare, complications after surgery (‘postoperative complications’) are another consideration. Graft failure (such as delamination or overgrowth) may make a further operation necessary. However, the risks can be minimised if due care is taken.

Physical therapists should work with surgeons to ensure that the rehabilitation is appropriate. Overly aggressive or demanding physical therapy too soon after the operation can cause graft complications and jeopardise optimal outcomes. With this in mind, both the both surgeon and physiotherapist should talk to the patient about the allowed ranges of motion and weight-bearing restrictions of the joint.

There is also the possibility that, despite the best efforts of the healthcare team, the procedure does not achieve the desired outcome. In such cases, the patient and the doctor will discuss future options and the potential for further treatments or procedures.

Relative risks

As cartilage repair procedures focus on the joints, the risk of accidental damage to major organs or blood vessels during surgery is minimal. However, there is a small risk of damage to surrounding structures, including vessels, nerves, or adjacent cartilage.

As the surgeries are planned, or ‘elective’, weighing the risks, benefits, and alternatives can be done well in advance. Similarly, ample time for pre-operative care means that higher risk patients with coexisting health concerns can be better prepared for surgery.

Importantly, when compared with the entire spectrum of surgical procedures, it is important to remember that elective cartilage repair is, overall, relatively safe and low-risk.

Frequently Asked Questions (FAQs)

How long after surgery will I be able to return home?

In most cases, cartilage procedures are performed on an outpatient basis, or might require only a very brief hospital stay. More complex procedures may require a longer length of stay.

What are the chances of an operation solving cartilage problems in the long-term?

Cartilage repair procedures are still relatively new field. There is little long-term data both on the natural history of untreated cartilage lesions or studies that can predict surgical results years and years into the future. That being said, encouraging mid-term results are hoped to carry on into the long-term.

Is there a minimum amount time off work I will need after the surgery?

After almost any cartilage repair procedure, the typical minimum amount of time that you will have to take off work is 6 weeks.

How much time off work will I need after the surgery?

This will depend on both the individual operation and the outcome. Ask your healthcare professional for more specific estimates.

Further reading

Many currently used cartilage repair techniques have excellent mid-term outcomes, and there is well-founded optimism that, as time progresses, there will be similarly encouraging long-term data on outcomes.

Currently there are several specific techniques and devices in the pipeline. In particular, bioengineered scaffoldscell-based therapies, and adjuvant growth factors are both in pre-clinical trials and clinical use elsewhere, and are expected to be available in the foreseeable future.

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