A more natural alternative to knee replacement

July 30, 2008 6:17:04 AM PDT
A growing number of aging athletes and weekend warriors are facing the flip side of playing sports into middle age with worn-out and damaged knees. The result is often an artificial knee replacement, but there is a surgeon in the Bay Area who is offering an alternative.

"I just played basketball constantly," said Jodi Lom, a knee surgery patient.

Jodi's college basketball career left her with more than memories. It left her with the scars from multiple knee surgeries and the prospect of a total knee replacement, while still in her thirties.

"I couldn't do anything. I was bone on bone. I could barely walk," said Jodi.

Instead of an artificial joint, a Bay Area surgeon rebuilt Jodi's knee by combining several procedures into a single surgery, to achieve what he calls, a biological knee replacement.

"There are two kinds of cartilage in the knee, first is the articular cartilage. This is the covering of the bone, when you get arthritis, it's wearing down articular cartilage to the bone," said Dr. Kevin Stone M.D., a surgeon from the Stone Clinic.

Dr. Stone runs a private clinic in San Francisco. He started by removing bone matter from deep in the hollow area inside Jodie's knee and grinding it into a paste.

"So we take that paste, bloody the arthritic area of the knee, and pact that paste back on. That paste has patients' own stem cells, and we can stimulate that to re-grow new cartilage," said Dr. Stone.

Next, and perhaps more challenging, Stone also replaced Jodi's meniscus, the pad like cartilage that acts like a shock absorber. The surgical transplant, with a cadaver meniscus, again involves stimulating the blood supply in the joint.

"It's a natural meniscus that your body grows cells back into and so it becomes your tissue, really within six weeks," said Dr. Stone.

With rehabilitation, he says patients treated with his combination technique are often able to continue participating in sports, potentially for years to come. Though most, he says, will eventually require a traditional knee replacement down the road.

Some surgeons also have doubts about whether combining several techniques into a single surgery is really producing measurably better results.

"There are not any really significantly large, long-term follow up on meniscus transplants," said Dr. James Garrick M.D., a surgeon with the St. Francis Medical Center.

Dr. Garrick believes less evasive, micro-fracture surgery could produce nearly the same relief.

"I'm not sure I believe in the more is better thing. And trying to get from 85 percent to 90 percent better results is very difficult to document and difficult to do," said Dr. Garrick.

Dr. Stone points to his own follow-up studies that show a high percentage of his patients reporting continued pain relief and increased range of motion years later. Jodi is among the believers.

"Two years ago, I did a triathlon. Now I swim and do spin classes, play with kids. So yes, it's been highly successful for me," said Jodi.

Dr. Stone says the biological knee repair is generally less expensive because it's done as an out-patient procedure. The average costs is between $10,000-$20,000 compared to $20,000 and up for an artificial total knee replacement.


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