Biologic Knee Replacement

Unicompartmental knee arthritis has usually been treated with conservative care followed by arthroscopic debridements, osteotomies, and eventually joint replacement. Many patients try to defer joint replacement and some request efforts at cartilage replacement. We have sought to improve our treatment of unicompartmental arthritis by combining new techniques of articular cartilage repair, meniscus allograft replacement and medial opening wedge osteotomy into a single outpatient procedure. We have called this, "Biologic Joint Replacement." Recognizing that these techniques are in their infancy, we present our surgical technique and the initial successes and failures at resurfacing arthritic joints in active people.

Since 1991 we have performed our technique of articular cartilage paste grafting on 124 patients. Of these patients, 32 underwent concurrent meniscal allograft replacements and 14 underwent medial opening wedge osteotomies to correct varus alignment. The combined surgical technique of articular cartilage paste grafting, a new technique of meniscal allograft insertion, and our technique of medial opening wedge osteotomy will be presented in detail. The inclusion criteria for these patients were predominately uni-compartmental arthritic changes with pain at the joint line and failure of conservative care. This conservative care typically includes NSAID's, cortisone, heel wedges, activity modification, and physical therapy. The patient had to verbalize a willingness to undergo unproven procedures that might lead to an earlier joint replacement.