RESUMEN
BACKGROUND: Focal chondral defects (FCDs) of the femoral condyle are common. Treatment has heretofore primarily consisted of non-surgical and biological treatments. Focal articular surface replacement (FASR) is an emerging technique utilizing small implants to essentially fill the FCD. Here we report functional outcome and re-operation rates following FASR as a primary treatment for FCDs of the femoral condyles. METHODS: Retrospective analysis of a prospectively collected database including 327 FASR procedures was performed to identify patients who underwent FASR of the femoral condyle with a modular cementless metallic implant (HemiCAPTM) as a primary procedure. Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), SF-36 Health Status Survey (SF-36) and Visual Analog Scale (VAS) were collected before and 6 weeks, 6 months, and 4 years after surgery. Implant revision and re-operation rate were recorded. RESULTS: 157 patients were included with a mean follow-up of 9.4 ± 1.3 years (range 7.0 to 11.4 years). The average age was 40.2 ± 5.3 years, 85% involved the medial condyle, and the average defect size was 3.6 ± 0.5 cm2. Primary FASR resulted in functional improvement on the KOOS (+52%), OKS (+69%) and SF-36 (+50%) scores and a reduction in VAS scores (-70%) at 4-year follow-up. Revision rate was 0.64% and the re-operation rate was 11%. CONCLUSION: This retrospective case-series supports primary FASR with HemiCAPTM implants as an alternative to biological procedures to treat medium-sized FCDs (2.5-4 cm2) of the femoral condyle, although long-term follow-up is necessary to determine if the clinical outcome and low revision rate can be maintained.
Asunto(s)
Cartílago Articular , Adulto , Cartílago Articular/lesiones , Cartílago Articular/cirugía , Fémur/cirugía , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Focal articular lesions of the knee can be treated using several different techniques with generally good results, but failures are difficult to manage. Focal articular surface replacement (FASR) using metal implants could be a promising technique that allows defect geometry matching, congruency restoration and defect propagation prevention. METHODS: 132 patients were included who underwent FASR between January 2009 and December 2013. Three different implants were used: 1. HemiCAP®; 2. UniCAP® and 3. HemiCAP® PF Classic for trochlear lesions. Primary outcome parameter was knee function assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score with a 4-year follow-up, secondary outcomes included survivorship and complications. Statistical analyses were performed using GraphPad Prism. RESULTS: For all 132 surgeries combined (102 HemiCAP®, 11 UniCAP® and 19 HemiCAP® PF Classic implants), WOMAC scores significantly improved from 6 weeks onward until the end of the study (p < 0.001 for all time points). 4-year survival rate was 97.7%, and a re-operation rate of 12.1% was found. The HemiCAP® group revealed a slower WOMAC improvement in patients aged ≥40 years, combined with a trend towards lower final WOMAC scores and a higher re-operation rate in patients with a BMI ≥ 25. CONCLUSIONS: This report shows good to excellent clinical results of FASR as a salvage procedure after failed cartilage repair, with a low re-operation rate and a high survival of 97.7% at 4-year follow-up. Although longer follow-up is required, this could be a valuable treatment option in these challenging cases, without limiting future options for surgical interventions when deemed necessary.
Asunto(s)
Cartílago Articular/cirugía , Articulación de la Rodilla/cirugía , Prótesis e Implantes , Adulto , Estudios de Seguimiento , Humanos , Medición de Resultados Informados por el Paciente , Complicaciones Posoperatorias , Reoperación , Terapia RecuperativaRESUMEN
Osteochondral fracture of the lateral femoral condyle can be a real challenging injury to diagnose on initial presentation. The authors report a rare case of bilateral involvement of posterior aspect of lateral femoral condyle osteochondral fracture in a young 15-year-old boy. This was managed with excision of these osteochondral fragments, as the site involved was on the posterior non-weight bearing area of the femur along with chronicity of the injury dictating excision as a reasonable choice of management. Good outcome for such injury is based on an early diagnosis and prompt treatment along with an early rehabilitation for such cases. Our patient has an excellent 2 years outcome with a Knee Society score of 95 after undergoing excision of these osteochondral fragments in both knees in succession.