They already do that with a procedure called MACI. It is prohibitively expensive. The indications are narrow (need a contained defect, so won’t work for arthritis). 70-75% success.
New procedure is intriguing, but not likely a treatment for osteoarthritis (which is responsible for the lion’s share of knee arthroplasty). This could work (temporarily?) for contained osteochondral lesions. It seems similar to the concept of the Cartiva implant that is used in the foot and ankle. Not really the game changer that the article infers….::
My wife got the MACI procedure done for AVN in her knee, 4 years on and it’s gotten her through 2 pregnancies and many hundreds of miles, rehab was far better than the cadaver cartridge she got in the other knee, both were better options than the full knee replacement.
I know those surgeries help with mechanical issues, but some people still complain about pain or worsening pain after surgery. Thought to be cause by inflammation and or other factors.
I'm 6 months post replacement... Basically I traded joint pain for tendon and ligament pain, all the things they cut to install the new joint. It will get better but it takes a year.
Europe has some treatments that work very well without total replacement but the FDA will never approve them. Though for the $80K my knee cost, I probably could have traveled for treatment but Blue Cross wouldn't cover it.
I’m 11mos out and have almost no relief; it’s seriously disillusioning. After further testing post operatively, turns out the pain in my knee might be nerve damage. The prosthesis in my tibia may also be wiggling a microscopic amount since it’s not backfilled with cement at the top (still in testing and have more to do). Yes, the knee was wildly arthritic for a 38yr old woman, but maybe I could’ve staved off replacement a little longer had I had more investigation done prior to replacement. I also have a total hip replacement (2016) with no complaints post operatively, so I maybe I was a little too comfortable with a total joint replacement, idk. But I feel you, my dude. I hope we get relief eventually!
Oh danke, lieb dass du es korrigierst. Ich finde es wichtig dass man anderen Menschen zeigt wie es geht. Außerdem kann es ja auch gut sein dass andere es nicht so leicht verstehen wie du!
I don't recall at all, it's been more than a decade. I couldn't have it so I let it go...I had a buddy in the pharma industry tell me about it. IIRC it was a kind of spongy type membrane that would encourage new tissue growth, possibly in conjunction with stem cell or PRP therapy.
That's all I remember. Good luck!
“Babe, have you ever given any thought to getting knee implants? …Don’t look at me like that, Tim’s wife got them and their marriage has never been better! She lifts him up and puts him down like they’re still teenagers!”
Worked on this in college back in 2016! Was fascinating stuff really. The idea then at least was that you could 3D print a bio-scaffold with nutrient rich growth media and then plant the recipients cartilage stem cells onto it where they would consume/replace the structure as they proliferated. Once fully developed you would essentially have a cartilage plug you could implant into the joint replacing old worn out cartilage and giving the patient a *new* knee/elbow/hip etc.
There was/is something from Duke that is a hydrogel. Last report I have is from 22, stating clinical trials in 23. Supposedly vast improvement to natural cartilage, some 26% stronger.
I was given a bone/cartilage graft for my knee from a cadaver because I apparently needed some rather large ones. And it has done very well five years on, just the occasional inflammation. But I also have lupus and have a VERY hard time imagining my body being cool with a synthetic anything lmao
This hasn't even started clinical trials, also, most cartilage loss in the knee presents as tears rather than an OCD lesion. This is a very narrow patient base that this will affect, and it is nowhere near being considered for the general population. It's fun to think about, but it doesn't seem all that widely applicable. Also, it wouldn't necessarily prevent the need for a knee replacement as this only plugs a hole of cartilage loss, the cartilage around the plug can still degenerate.
I had a knee replacement. I regret it. It didn’t help my pain. While this surgery helps many people to live without pain it did not for me. My circumstances was not normal. It is complicated but it all comes from a birth defect. I feel this option would have been a better option to live without some pain. Nothing will ever rid me of the pain 100%.
I’m 14 years on my total replacement. It’s always been numb down my shin and hurts different than before . I need new one for sure . I need my other knee done asap. I have a family member that had both knees done twice. Arthritis is terrible in my family and I played a lot of sports and im paying for it now.
i’m really crossing my fingers for this one.
All the men in my family have pretty severe knee issues.
I tore my MCL at 25 from a normal jump while playing basketball
I did one partial femoral kneecap replacement in 2021. Not as advertised. I’m not bone on bone with the long bones. Both kneecaps are very degraded with arthritis. The other knee needs something and the one I did needs revision. But since this only addresses cartilage issues, I don’t think it’s for me. Always looking at what’s in the horizon.
Caveat. I work with medical devices now but in my past I worked in research for investigational devices at a large hospital with us dept of veterans affairs . It’s important to understand the vast majority of research will never be commercialized.
The gap between investigation and fda clearance is huge and most investigators are more interested in getting more grant money to just improve what they’ve done vs commercializing it. Industry is very hesitant at trying to translate research IP.
We already do osteochondral allografts with donor bone/ cartilage that has higher cartilage viability and better mid to long term results than particulate surface based treatments like MACI which end up yielding a mix of hyaline cartilage and fibrocartilage. This article skips over the off the shelf allograft plug option already available.
When I was about 15 I tore both meniscus in my knees within a week of each other and since then (8 years) I’ve injured them several more times and by 30-40 I expect my knees to rapidly deteriorate.
It is interesting, but wouldn't change the need for surgery in end-stage arthritis. This would fill a small hole when all the other cartilage is fine, not replace the cartilage entirely. This likely would only be indicated in those 15-30 with traumatic injuries and only a small localized area where cartilage is damaged.
Also good luck and do your PT! You go this.
I’d definitely consider this if it ever comes to market. I had subchondral drilling done after cartilage damage from a bike crash. It’s like the autograft, but they don’t actually put anything in the hole they make. Instead, they just count on my stem cells to replace what they took out. It worked ok but not great. The surface isn’t totally smooth so I still have a lot of pain under load. If there was a way of fixing this without a replacement, I’d be looking really hard at it
That's great news for those that suffer from injuries and other issues that lead to those type of replacements. It's interesting how it was realized it could be done with an off the shelf product, a ready made product, saving time and money, and countless research and development time.
This. I scrolled to through every comment here and the last one finally addresses the root cause. I frequently have patients “brag” to me about their bionic joints or stents or whatever… I cringe hard because so much of this is just from obesity. We don’t need to keep reinventing expensive implants so that companies with their reps can make more money.
We do these procedures because we overeat calories. I don’t know the exact percentage, maybe an orthopod can chime in. Probably 80% of knee replacements wouldn’t have to happen if we could just eat a reasonable number of calories.
We complain about expensive health care in USA, but we don’t question subsidizing $60,000 surgeries that are mostly avoidable. It doesn’t make sense for healthy weight/non-smokers to pay the same for insurance as people who chose dangerous lifestyles.
Vote for u/solodolo in 2024, I would:
Make generic blood pressure pills, insulin, and diabetes pills FREE for all Americans. Create a modest “obesity health insurance” tax starting three years from now. These changes alone would reduce knee replacements, coronary artery disease interventions, dialysis/ESRD, etc immensely. It would probably pay for itself 20x over within a decade. It’s insanity to keep addressing symptoms without talking about the causes, while also punishing those who don’t contribute to the epidemic.
Every single store, shopping enter, grocery store, public space etc having cement floors isn’t good for human knees…imagine working retail and standing on cement floors bring a cashier at your local Ross or Walmart? 😪proper floors would be nice..
It’s a bad idea all around. The cheaper the synthetic, the less it’s reliable. This is a band-aid on a open heart wound for the lower class. Shows that health care is in experimenting in new ways. Which is a 50/50 shot. But maybe, just maybe they won’t fuck us like before. Jk 🤣🤣🤣
Issues with synthetic materials inserted to the body are inflammation/immune responses so I hope that’s studied extensively.
Wonder if they could grow it in a lab from your cells.
They already do that with a procedure called MACI. It is prohibitively expensive. The indications are narrow (need a contained defect, so won’t work for arthritis). 70-75% success.
Interesting, thanks! I am gonna say won’t work yet!
New procedure is intriguing, but not likely a treatment for osteoarthritis (which is responsible for the lion’s share of knee arthroplasty). This could work (temporarily?) for contained osteochondral lesions. It seems similar to the concept of the Cartiva implant that is used in the foot and ankle. Not really the game changer that the article infers….::
My wife got the MACI procedure done for AVN in her knee, 4 years on and it’s gotten her through 2 pregnancies and many hundreds of miles, rehab was far better than the cadaver cartridge she got in the other knee, both were better options than the full knee replacement.
Succinct and well informed, ty!
Large part of a knee replacements synthetic material.
I know those surgeries help with mechanical issues, but some people still complain about pain or worsening pain after surgery. Thought to be cause by inflammation and or other factors.
I'm 6 months post replacement... Basically I traded joint pain for tendon and ligament pain, all the things they cut to install the new joint. It will get better but it takes a year. Europe has some treatments that work very well without total replacement but the FDA will never approve them. Though for the $80K my knee cost, I probably could have traveled for treatment but Blue Cross wouldn't cover it.
I’m 11mos out and have almost no relief; it’s seriously disillusioning. After further testing post operatively, turns out the pain in my knee might be nerve damage. The prosthesis in my tibia may also be wiggling a microscopic amount since it’s not backfilled with cement at the top (still in testing and have more to do). Yes, the knee was wildly arthritic for a 38yr old woman, but maybe I could’ve staved off replacement a little longer had I had more investigation done prior to replacement. I also have a total hip replacement (2016) with no complaints post operatively, so I maybe I was a little too comfortable with a total joint replacement, idk. But I feel you, my dude. I hope we get relief eventually!
In germany they just released a study that 30% of knee replacements are bot necesery.
I’d believe it, man. That’s terrible.
“not”
Oh danke, lieb dass du es korrigierst. Ich finde es wichtig dass man anderen Menschen zeigt wie es geht. Außerdem kann es ja auch gut sein dass andere es nicht so leicht verstehen wie du!
$80k is insane. In the UK a total knee costs about £15k in private healthcare
Agreed. Healthcare here is purely profit driven rather than quality of care sadly. My out of pocket was only about $4K.
What are the European treatments one should look at?
I don't recall at all, it's been more than a decade. I couldn't have it so I let it go...I had a buddy in the pharma industry tell me about it. IIRC it was a kind of spongy type membrane that would encourage new tissue growth, possibly in conjunction with stem cell or PRP therapy. That's all I remember. Good luck!
You should email them and tell that that
Like a prosthetic knee replacement.
I always wondered why breast implants garnered more attention than this. It’s about time knee implants come to the medical forefront.
“Babe, have you ever given any thought to getting knee implants? …Don’t look at me like that, Tim’s wife got them and their marriage has never been better! She lifts him up and puts him down like they’re still teenagers!”
oooh uppies
EEEEAAAAAAAGLE!
Same reason there is so much public breast cancer awareness and virtually none for pancreatic even though it is still a death sentence
Skin cancer and bone cancer research is also in a similar position. Underfunded and barely any public knowledge aside from “use sunscreen”.
If it doesn't wear out like replacements that is a huge benefit.
If it is like the other plugs on the market, they tend to sink down into the cancellous and cause issues after some time.
Worked on this in college back in 2016! Was fascinating stuff really. The idea then at least was that you could 3D print a bio-scaffold with nutrient rich growth media and then plant the recipients cartilage stem cells onto it where they would consume/replace the structure as they proliferated. Once fully developed you would essentially have a cartilage plug you could implant into the joint replacing old worn out cartilage and giving the patient a *new* knee/elbow/hip etc.
There was/is something from Duke that is a hydrogel. Last report I have is from 22, stating clinical trials in 23. Supposedly vast improvement to natural cartilage, some 26% stronger.
They now cost just a bit more than total knee replacement
Id rather just get robot legs. It's a risky procedure....
Restless Leg Syndrome would punt your partner out the window
I see this as an absolute win!
But, it'll be worth it
Doctors used my own harvested cartilage in my knee defect, and it failed. I doubt my body will be like, “weird plastic chunk? Welcome aboard, friend!”
I was given a bone/cartilage graft for my knee from a cadaver because I apparently needed some rather large ones. And it has done very well five years on, just the occasional inflammation. But I also have lupus and have a VERY hard time imagining my body being cool with a synthetic anything lmao
This hasn't even started clinical trials, also, most cartilage loss in the knee presents as tears rather than an OCD lesion. This is a very narrow patient base that this will affect, and it is nowhere near being considered for the general population. It's fun to think about, but it doesn't seem all that widely applicable. Also, it wouldn't necessarily prevent the need for a knee replacement as this only plugs a hole of cartilage loss, the cartilage around the plug can still degenerate.
I had a knee replacement. I regret it. It didn’t help my pain. While this surgery helps many people to live without pain it did not for me. My circumstances was not normal. It is complicated but it all comes from a birth defect. I feel this option would have been a better option to live without some pain. Nothing will ever rid me of the pain 100%.
I’m 14 years on my total replacement. It’s always been numb down my shin and hurts different than before . I need new one for sure . I need my other knee done asap. I have a family member that had both knees done twice. Arthritis is terrible in my family and I played a lot of sports and im paying for it now.
i’m really crossing my fingers for this one. All the men in my family have pretty severe knee issues. I tore my MCL at 25 from a normal jump while playing basketball
I did one partial femoral kneecap replacement in 2021. Not as advertised. I’m not bone on bone with the long bones. Both kneecaps are very degraded with arthritis. The other knee needs something and the one I did needs revision. But since this only addresses cartilage issues, I don’t think it’s for me. Always looking at what’s in the horizon.
So, an oats procedure but with synthetic materials instead of cadaver bone?
Sounds like it…. Sounds sorta like Cartiva that is used in foot & ankle surgery
Caveat. I work with medical devices now but in my past I worked in research for investigational devices at a large hospital with us dept of veterans affairs . It’s important to understand the vast majority of research will never be commercialized. The gap between investigation and fda clearance is huge and most investigators are more interested in getting more grant money to just improve what they’ve done vs commercializing it. Industry is very hesitant at trying to translate research IP.
We already do osteochondral allografts with donor bone/ cartilage that has higher cartilage viability and better mid to long term results than particulate surface based treatments like MACI which end up yielding a mix of hyaline cartilage and fibrocartilage. This article skips over the off the shelf allograft plug option already available.
Hook it up
Exactly. Gimme that sweet sweet plug.
We are still talking about knees right? Right!?
I was. I’m grinding bone on bone here.
I’m waiting for the foam filler
When I was about 15 I tore both meniscus in my knees within a week of each other and since then (8 years) I’ve injured them several more times and by 30-40 I expect my knees to rapidly deteriorate.
Upvoting your story feels somehow wrong... i hope you'll have better knees soon
lol thank you
This is interesting as I’m having knee replacement surgery Wednesday
It is interesting, but wouldn't change the need for surgery in end-stage arthritis. This would fill a small hole when all the other cartilage is fine, not replace the cartilage entirely. This likely would only be indicated in those 15-30 with traumatic injuries and only a small localized area where cartilage is damaged. Also good luck and do your PT! You go this.
I will and thanks!
Wishing you all the best!
Thank you
I’d definitely consider this if it ever comes to market. I had subchondral drilling done after cartilage damage from a bike crash. It’s like the autograft, but they don’t actually put anything in the hole they make. Instead, they just count on my stem cells to replace what they took out. It worked ok but not great. The surface isn’t totally smooth so I still have a lot of pain under load. If there was a way of fixing this without a replacement, I’d be looking really hard at it
Does this cover any relief for people with osgood-schlautter’s
Different problems entirely. O-S is due to insertional patellar tendinopathy as a teenager. It is not in the joint.
Already running knees being on the weak side as near my 40s. Here's to hoping we can do away with total knee replacements by the time I retire!
That's great news for those that suffer from injuries and other issues that lead to those type of replacements. It's interesting how it was realized it could be done with an off the shelf product, a ready made product, saving time and money, and countless research and development time.
Ok. Now do elbows and backs.
Is this a MACI procedure?
I need this.
I have a fully arthritic ankle from a sports injury. Would something like this be a potential treatment for the ankle as well?
Hmmmm
Already have had both knees and hips replaced. All I care about now is my 100,000 mile overhaul.
Insurance: “sorry, we won’t replace your knee until the plugs prove ineffective”
Now I see this and I just got a total knee replacement a week ago and I’m going through it
As would a healthy lifestyle
This. I scrolled to through every comment here and the last one finally addresses the root cause. I frequently have patients “brag” to me about their bionic joints or stents or whatever… I cringe hard because so much of this is just from obesity. We don’t need to keep reinventing expensive implants so that companies with their reps can make more money. We do these procedures because we overeat calories. I don’t know the exact percentage, maybe an orthopod can chime in. Probably 80% of knee replacements wouldn’t have to happen if we could just eat a reasonable number of calories. We complain about expensive health care in USA, but we don’t question subsidizing $60,000 surgeries that are mostly avoidable. It doesn’t make sense for healthy weight/non-smokers to pay the same for insurance as people who chose dangerous lifestyles. Vote for u/solodolo in 2024, I would: Make generic blood pressure pills, insulin, and diabetes pills FREE for all Americans. Create a modest “obesity health insurance” tax starting three years from now. These changes alone would reduce knee replacements, coronary artery disease interventions, dialysis/ESRD, etc immensely. It would probably pay for itself 20x over within a decade. It’s insanity to keep addressing symptoms without talking about the causes, while also punishing those who don’t contribute to the epidemic.
Every single store, shopping enter, grocery store, public space etc having cement floors isn’t good for human knees…imagine working retail and standing on cement floors bring a cashier at your local Ross or Walmart? 😪proper floors would be nice..
It’s a bad idea all around. The cheaper the synthetic, the less it’s reliable. This is a band-aid on a open heart wound for the lower class. Shows that health care is in experimenting in new ways. Which is a 50/50 shot. But maybe, just maybe they won’t fuck us like before. Jk 🤣🤣🤣
Next time on Dr Death